Basic Information
| Provider Information | |||||||||
| NPI: | 1568464030 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OSBORN | ||||||||
| FirstName: | CAROL | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 461 E 200 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841112102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015192461 | ||||||||
| FaxNumber: | 8015963785 | ||||||||
| Practice Location | |||||||||
| Address1: | 461 E 200 S | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | SALT LAKE CITY | ||||||||
| State: | UT | ||||||||
| PostalCode: | 841112102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8015192461 | ||||||||
| FaxNumber: | 8015963785 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2005 | ||||||||
| LastUpdateDate: | 12/13/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 175520-1205 | UT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.