Provider Demographics
NPI:1528229630
Name:OSBORNE, ROGER LEE
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:LEE
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 11TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:STEWARTVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55976-1589
Mailing Address - Country:US
Mailing Address - Phone:507-533-9303
Mailing Address - Fax:
Practice Address - Street 1:501 11TH AVE NE
Practice Address - Street 2:
Practice Address - City:STEWARTVILLE
Practice Address - State:MN
Practice Address - Zip Code:55976-1589
Practice Address - Country:US
Practice Address - Phone:507-533-9303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1028840-1-AFC171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor