Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 20033 | SC |
N | 2086S0129X | Vascular Surgeon | 20033 | SC |
NPI | 1003027822 |
---|---|
Provider Name | John Jay Osborn |
First Address | Sanford, NC 27332-6192 |
Second Address | Ft Hood, TX 76544-5095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 15/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F33876 | (02) | SC |
GP2021 | (05) | SC |