Healthcare Provider Details

I. General information

NPI: 1124272331
Provider Name (Legal Business Name): ALEXANDER JUSTIN OSBORN MD/PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2008
Last Update Date: 05/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 2018
CINCINNATI OH
45229-3026
US

IV. Provider business mailing address

3333 BURNET AVE ML 2018
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4355
  • Fax: 513-636-8133
Mailing address:
  • Phone: 513-636-4355
  • Fax: 513-636-8133

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number35.098453
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: