Provider Demographics
NPI:1942356563
Name:OSGOOD, KEVIN GLEN (MD)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:GLEN
Last Name:OSGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4701 BEE CAVES RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5366
Mailing Address - Country:US
Mailing Address - Phone:512-518-4992
Mailing Address - Fax:866-298-0735
Practice Address - Street 1:4701 BEE CAVES RD STE 201
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5366
Practice Address - Country:US
Practice Address - Phone:512-518-4992
Practice Address - Fax:866-298-0735
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN1814207RR0500X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00813246OtherRRMCR
TXP00813246OtherRRMCR
TX8L14839Medicare PIN