Provider Demographics
NPI:1063463297
Name:OSBAN, WENDY W (DO)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:W
Last Name:OSBAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2699
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32513-2699
Mailing Address - Country:US
Mailing Address - Phone:850-475-4500
Mailing Address - Fax:850-475-4619
Practice Address - Street 1:1549 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8633
Practice Address - Country:US
Practice Address - Phone:850-416-7008
Practice Address - Fax:850-416-7003
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2011-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8405207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL261182100Medicaid
FL261182100Medicaid
FL58826Medicare ID - Type Unspecified