Provider Demographics
NPI:1417136078
Name:OSBORNE, JAMES B JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:B
Last Name:OSBORNE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:929 US HWY 441
Practice Address - Street 2:SUITE 401
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3002
Practice Address - Country:US
Practice Address - Phone:352-751-0981
Practice Address - Fax:352-751-0984
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2020-11-16
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Provider Licenses
StateLicense IDTaxonomies
VI0101253771208600000X
FLME146920208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1417136078Medicaid
VAP01315276OtherRAILROAD MEDICARE
VAC09949Medicare UPIN
VA1417136078Medicaid