Healthcare Provider Details

I. General information

NPI: 1205350808
Provider Name (Legal Business Name): KILBY P OSBORN IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2017
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 FLORIDA MEMORIAL PKWY STE 2200
NEW SMYRNA BEACH FL
32168-9309
US

IV. Provider business mailing address

125 FLORIDA MEMORIAL PKWY STE 2200
NEW SMYRNA BEACH FL
32168-9309
US

V. Phone/Fax

Practice location:
  • Phone: 386-409-6839
  • Fax:
Mailing address:
  • Phone: 386-409-6839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number16882
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9562
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01094889A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME178773
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number37500
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: