Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 39000000X | NY |
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | OS17563 | FL |
NPI | 1528412236 |
---|---|
Provider Name | Nathaniel Osborn |
First Address | Miami, FL 33136-1005 |
Second Address | New Stanton, PA 15672 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2016 |
Last Update Date | 05/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1528412236 | (05) | PA |