Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | AZ4439 | AZ |
NPI | 1912944042 |
---|---|
Provider Name | James William Osborne |
First Address | Phoenix, AZ 85029-4608 |
Second Address | Phoenix, AZ 85029-4608 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 19/05/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I58945 | (02) | AZ |