Provider Demographics
NPI:1093701211
Name:OSBORN, DANIEL R (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1531 E BRADFORD PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-6566
Mailing Address - Country:US
Mailing Address - Phone:417-887-3900
Mailing Address - Fax:417-887-3221
Practice Address - Street 1:1531 E BRADFORD PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-6566
Practice Address - Country:US
Practice Address - Phone:417-887-3900
Practice Address - Fax:417-887-3221
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO109897207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000013492OtherMEDICARE GROUP
MO15380OtherBCBS
MO284256OtherHEALTHLINK
MO9960432OtherCIGNA
MO208181305Medicaid
MO508027802OtherMEDICAID GROUP
MOCJ4614OtherMEDICARE RAILROAD GROUP
MO000013493OtherMEDICARE GROUP RURAL
MOCJ4613OtherMEDICARE RAILROAD GROUP
MO0800181OtherUHC
MO208181305Medicaid
MO9960432OtherCIGNA
MOG10487Medicare UPIN
MO000013493OtherMEDICARE GROUP RURAL
MOCJ4614OtherMEDICARE RAILROAD GROUP