Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 2901018951 | MI |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 4947070-9924 | UT |
N | 204E00000X | Oral & Maxillofacial Surgeon | 2901018951 | MI |
NPI | 1427127422 |
---|---|
Provider Name | Dr. Jeffrey Avaron Osguthorpe |
First Address | West Valley, UT 84120-6250 |
Second Address | West Valley, UT 84120-6250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 15/04/2019 |