Provider Demographics
NPI:1710999727
Name:OSBORNE, HEROLD SCOTT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:HEROLD
Middle Name:SCOTT
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 N FOURTH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-0038
Mailing Address - Country:US
Mailing Address - Phone:903-757-3881
Mailing Address - Fax:903-757-5948
Practice Address - Street 1:3535 N FOURTH ST STE 400
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-0038
Practice Address - Country:US
Practice Address - Phone:903-757-3881
Practice Address - Fax:903-757-5948
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01750363A00000X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA01750OtherSTATE PA LICENSE
TX8L27392OtherMEDICARE INDIVIDUAL PIN
TXS37805Medicare UPIN
TXPA01750OtherSTATE PA LICENSE