MEDICARE: AUDLEY LLOYD MARTIN OSBOURNE MD

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	208800000X	Urology Physician	ME113487	FL
2	208600000X	Surgery Physician	L-224804	MA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P01604782	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14426	OTHER	FL	DIMENSION
2	14NN3	OTHER	FL	BCBS
3	P971629	OTHER	FL	OPTIMUM
4	1096529	OTHER	FL	WELLCARE
5	0363920	OTHER	FL	CIGNA
6	9155643	OTHER	FL	AETNA
7	362745	OTHER	FL	AVMED
9	P1035875	OTHER	FL	FREEDOM

General Provider Information

NPI Number	:	1992900062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDLEY LLOYD MARTIN OSBOURNE MD

Provider Business Mailing Address
First Line	:	402 W COLTON AVE
Second Line	:
City	:	REDLANDS
State	:	CA
Zip	:	92374-3108
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11620 WILSHIRE BLVD STE 600
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1776
Country	:	US
Telephone Number	:	310-876-5649
Fax Number	:

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

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	12/10/2025

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Directions to “ AUDLEY LLOYD MARTIN OSBOURNE MD” Practice Location

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