Healthcare Provider Details

I. General information

NPI: 1528042496
Provider Name (Legal Business Name): ROSS QUINN OSBORN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 VILLAGE OAKS DR
FRUIT COVE FL
32259-3876
US

IV. Provider business mailing address

201 VILLAGE OAKS DR
FRUIT COVE FL
32259-3876
US

V. Phone/Fax

Practice location:
  • Phone: 904-240-0442
  • Fax: 904-240-2471
Mailing address:
  • Phone: 904-240-0442
  • Fax: 904-240-2471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberME89577
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: