Provider Demographics
NPI:1528061132
Name:OSBORN, DUSTAN C (MD, PHD)
Entity type:Individual
Prefix:MR
First Name:DUSTAN
Middle Name:C
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 BISHOP RD
Mailing Address - Street 2:
Mailing Address - City:CHEHALIS
Mailing Address - State:WA
Mailing Address - Zip Code:98532-8711
Mailing Address - Country:US
Mailing Address - Phone:360-345-1381
Mailing Address - Fax:360-345-1382
Practice Address - Street 1:1201 BISHOP RD
Practice Address - Street 2:
Practice Address - City:CHEHALIS
Practice Address - State:WA
Practice Address - Zip Code:98532-8711
Practice Address - Country:US
Practice Address - Phone:360-345-1381
Practice Address - Fax:360-345-1382
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2022-06-30
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
WAMD00021486174400000X, 207RH0003X
MTMED-PHYS-LIC-109470207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No174400000XOther Service ProvidersSpecialist
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1011980Medicaid
WA1011980Medicaid
WAAO8284Medicare UPIN