Provider Demographics
NPI:1932104049
Name:OSBORN, BRETT A (DO)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:A
Last Name:OSBORN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HERITAGE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3000
Mailing Address - Country:US
Mailing Address - Phone:561-935-9233
Mailing Address - Fax:
Practice Address - Street 1:600 HERITAGE DR
Practice Address - Street 2:SUITE 105
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-3000
Practice Address - Country:US
Practice Address - Phone:561-935-9233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8838207T00000X
WV2348207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL267635400Medicaid
WV7446981OtherCIGNA
OH000000287951OtherUNISON
WV613918805OtherBLACK LUNG/FEC
WV3810014250Medicaid
OH3003369Medicaid
FL81127Medicare ID - Type Unspecified
FL267635400Medicaid
WV7446981OtherCIGNA
FL81127AMedicare PIN
FLP00257079Medicare PIN