Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 4298 | AR |
Y | 213EG0000X | General Practice | 4298 | AR |
NPI | 1003392218 |
---|---|
Provider Name | Grant Brennan Oserowsky |
First Address | Rogers, AR 72758-5097 |
Second Address | Springdale, AR 72764-4469 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2018 |
Last Update Date | 11/07/2018 |