Provider Demographics
NPI:1598792129
Name:OSLAND, JOHN D (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:D
Last Name:OSLAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1344 WINTERGREEN LN NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-5118
Mailing Address - Country:US
Mailing Address - Phone:206-842-5632
Mailing Address - Fax:206-842-5992
Practice Address - Street 1:1344 WINTERGREEN LN NE
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110
Practice Address - Country:US
Practice Address - Phone:206-842-5632
Practice Address - Fax:206-842-5992
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS24179207X00000X
WAMD60650967207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100315980AMedicaid
KS12149388OtherMULTIPLAN
KS16960OtherCOVENTRY
KS053669OtherBCBS
KS200385OtherHPK
KS10913OtherPHS
G28307Medicare UPIN