Healthcare Provider Details

I. General information

NPI: 1457359572
Provider Name (Legal Business Name): JEFFREY THOMAS OSBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1661 E CAMELBACK RD STE 160
PHOENIX AZ
85016-3921
US

IV. Provider business mailing address

919 12TH PL STE 1
PRESCOTT AZ
86305-1433
US

V. Phone/Fax

Practice location:
  • Phone: 602-241-1671
  • Fax: 602-230-7982
Mailing address:
  • Phone: 928-778-4300
  • Fax: 928-771-0920

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number30149
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: