Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 2011033543 | MO |
Y | 208200000X | Surgeon | 2011033543 | MO |
Y | 208600000X | Surgeon | 2011033543 | MO |
N | 2086S0102X | Surgical Critical Care | 2011033543 | MO |
N | 208D00000X | General Practice Physician | 2011033543 | MO |
NPI | 1245438050 |
---|---|
Provider Name | Dr. Tiffany M Osborn |
First Address | Saint Louis, MO 63110-1010 |
Second Address | Saint Louis, MO 63110-1003 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2007 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
206609000 | (05) | MO |