Healthcare Provider Details

I. General information

NPI: 1568425585
Provider Name (Legal Business Name): CHRISTINE R OSMON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 06/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WESTPORT PLZ SUITE 300
SAINT LOUIS MO
63146-3109
US

IV. Provider business mailing address

55 WESTPORT PLZ SUITE 300
SAINT LOUIS MO
63146-3109
US

V. Phone/Fax

Practice location:
  • Phone: 314-548-4772
  • Fax: 770-666-9118
Mailing address:
  • Phone: 314-548-4772
  • Fax: 770-666-9118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2001009499
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: