Healthcare Provider Details

I. General information

NPI: 1629697370
Provider Name (Legal Business Name): GEOFFREY DAVID OSBORNE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 GLENDALE AVE
TOLEDO OH
43614-2426
US

IV. Provider business mailing address

6033 SUNWOOD PL
WESTERVILLE OH
43081-3823
US

V. Phone/Fax

Practice location:
  • Phone: 419-383-5502
  • Fax: 419-383-5515
Mailing address:
  • Phone: 614-943-1286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301511050
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35.149555
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: