Individual
TOM OSBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1120 25TH AVE, BLACK EAGLE, MT 59414-1037
(406) 452-9834
(406) 453-3940
Mailing address
1120 25TH AVE, BLACK EAGLE, MT 59414-1037
(406) 452-9834
(406) 453-3940
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
193766
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
136084
—
MT
05
—
193766
—
MT
Enumeration date
10/05/2015
Last updated
10/05/2015
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