Provider Demographics
NPI:1669446225
Name:OSBORN, JAMES MARK (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MARK
Last Name:OSBORN
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 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:918-542-3900
Mailing Address - Fax:918-542-3928
Practice Address - Street 1:21 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6815
Practice Address - Country:US
Practice Address - Phone:918-542-3900
Practice Address - Fax:918-542-3928
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK16251207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100137110AMedicaid
OK100743480AMedicaid
KS100160970AMedicaid
OK100736700OMedicaid
MO2077109601Medicaid
KS100160970AMedicaid
OK299054YKW9Medicare PIN
OK080073153Medicare PIN