Provider Demographics
NPI:1265864375
Name:OSBORN, MATTHEW R (PA)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:R
Last Name:OSBORN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:RIO GRANDE CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78582-3803
Mailing Address - Country:US
Mailing Address - Phone:956-488-1200
Mailing Address - Fax:956-256-1846
Practice Address - Street 1:201 E 2ND ST
Practice Address - Street 2:
Practice Address - City:RIO GRANDE CITY
Practice Address - State:TX
Practice Address - Zip Code:78582-3803
Practice Address - Country:US
Practice Address - Phone:956-488-1200
Practice Address - Fax:956-256-1846
Is Sole Proprietor?:No
Enumeration Date:2013-07-31
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08471363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant