Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 5694 | AL |
NPI | 1033416730 |
---|---|
Provider Name | James Osborn |
First Address | Selma, AL 36701-7756 |
Second Address | Selma, AL 36701-7756 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2011 |
Last Update Date | 16/02/2011 |