Healthcare Provider Details

I. General information

NPI: 1457882854
Provider Name (Legal Business Name): OSMUND NOGRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2017
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ADULT MEDICAL CARE CLINIC TWENTYNINE PALMS 1546 6TH ST
TWENTYNINE PALMS CA
92277
US

IV. Provider business mailing address

ADULT MEDICAL CARE CLINIC TWENTYNINE PALMS 1546 6TH ST
TWENTYNINE PALMS CA
92277
US

V. Phone/Fax

Practice location:
  • Phone: 760-830-2552
  • Fax:
Mailing address:
  • Phone: 760-830-2552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101265350
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: