Healthcare Provider Details

I. General information

NPI: 1336179399
Provider Name (Legal Business Name): TIMOTHY BARTON OSBON MD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1156 BOWMAN RD UNIT 103
MOUNT PLEASANT SC
29464-3803
US

IV. Provider business mailing address

1156 BOWMAN RD UNIT 103
MOUNT PLEASANT SC
29464-3803
US

V. Phone/Fax

Practice location:
  • Phone: 843-654-7337
  • Fax:
Mailing address:
  • Phone: 843-654-7337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25298
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number25298
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: