Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 8910 | TX |
NPI | 1487760120 |
---|---|
Provider Name | Dr. Peter Osborne |
First Address | Sugar Land, TX 77479-3149 |
Second Address | Sugar Land, TX 77479-3149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U91042 | (02) | TX |