Healthcare Provider Details

I. General information

NPI: 1053994434
Provider Name (Legal Business Name): GEOFFREY THOMAS OSMOND NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2021
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11760 S 700 E STE 112
DRAPER UT
84020-6605
US

IV. Provider business mailing address

6082 W CEDAR FORK DR
WEST JORDAN UT
84081-5746
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-1186
  • Fax:
Mailing address:
  • Phone: 801-318-4547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5641076-4405
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5641076-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: