Provider Demographics
NPI:1528042496
Name:OSBORN, ROSS QUINN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:QUINN
Last Name:OSBORN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:115 BARTRAM OAKS WALK
Mailing Address - Street 2:SUITE 104
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32259-3243
Mailing Address - Country:US
Mailing Address - Phone:904-240-0442
Mailing Address - Fax:904-240-2471
Practice Address - Street 1:115 BARTRAM OAKS WALK
Practice Address - Street 2:SUITE 104
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-3243
Practice Address - Country:US
Practice Address - Phone:904-240-0442
Practice Address - Fax:904-240-2471
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89577207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2695634-00Medicaid
FL2695634-00Medicaid
FL37974Medicare ID - Type Unspecified