Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E2287 | CA |
Y | 222Z00000X | Podiatrist | E2287 | CA |
NPI | 1053365999 |
---|---|
Provider Name | Dr. Randall D Osborn |
First Address | Vacaville, CA 95687 |
Second Address | Vacaville, CA 95687 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2006 |
Last Update Date | 23/11/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T11260 | (02) |