Healthcare Provider Details

I. General information

NPI: 1700264678
Provider Name (Legal Business Name): GEOFFREY OSGOOD II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2015
Last Update Date: 08/30/2021
Certification Date: 08/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

963 BUTTE ST
REDDING CA
96001-0828
US

IV. Provider business mailing address

3596 AMERICANA WAY
REDDING CA
96003-5319
US

V. Phone/Fax

Practice location:
  • Phone: 530-245-5900
  • Fax:
Mailing address:
  • Phone: 313-505-5821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberE-13334
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number149034
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: