Healthcare Provider Details

I. General information

NPI: 1295092583
Provider Name (Legal Business Name): MARLON OSBOURNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 01/17/2024
Certification Date: 01/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3561 SW 10TH ST
POMPANO BEACH FL
33069-4827
US

IV. Provider business mailing address

3561 SW 10TH ST
POMPANO BEACH FL
33069-4827
US

V. Phone/Fax

Practice location:
  • Phone: 954-977-7959
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberME121731
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberME121731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: