Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 011806 | MO |
NPI | 1003880709 |
---|---|
Provider Name | Dr. James W Osborne |
First Address | Lake Winnebago, MO 64034-9319 |
Second Address | Raytown, MO 64138-1815 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
12489023 | BLUE CROSS BLUE SHIELD KC (01) | MO |
801465 | UNITED CONCORDIA (01) | MO |