Healthcare Provider Details

I. General information

NPI: 1417136078
Provider Name (Legal Business Name): JAMES B OSBORNE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 11/16/2020
Certification Date: 11/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 US HWY 441 SUITE 401
LADY LAKE FL
32159-3002
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINEVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-751-0981
  • Fax: 352-751-0984
Mailing address:
  • Phone: 352-416-1082
  • Fax: 352-373-6144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0101253771
License Number StateVI
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME146920
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: