MEDICARE: DR. DANIEL R OSBORN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	109897	MO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000013492	OTHER	MO	MEDICARE GROUP
7	CJ4614	OTHER	MO	MEDICARE RAILROAD GROUP
8	000013493	OTHER	MO	MEDICARE GROUP RURAL
9	CJ4613	OTHER	MO	MEDICARE RAILROAD GROUP

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	15380	OTHER	MO	BCBS
3	284256	OTHER	MO	HEALTHLINK
4	9960432	OTHER	MO	CIGNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
10	0800181	OTHER	MO	UHC

General Provider Information

NPI Number	:	1093701211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DANIEL R OSBORN M.D.

Provider Business Mailing Address
First Line	:	1531 E BRADFORD PKWY
Second Line	:	SUITE 100
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6566
Country	:	US
Telephone Number	:	417-887-3900
Fax Number	:	417-887-3221

Provider Business Practice Location Address
First Line	:	1531 E BRADFORD PKWY
Second Line	:	SUITE 100
City	:	SPRINGFIELD
State	:	MO
Zip	:	65804-6566
Country	:	US
Telephone Number	:	417-887-3900
Fax Number	:	417-887-3221

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2005
Last Update Date	:	12/21/2010

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