Provider Demographics
NPI:1932291820
Name:OSBORNE, EARL (LAT)
Entity Type:Individual
Prefix:
First Name:EARL
Middle Name:
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:LAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CAY CT
Mailing Address - Street 2:
Mailing Address - City:ANGLETON
Mailing Address - State:TX
Mailing Address - Zip Code:77515-3801
Mailing Address - Country:US
Mailing Address - Phone:979-849-0034
Mailing Address - Fax:
Practice Address - Street 1:1900 N DOWNING
Practice Address - Street 2:EARL OSBORNE ANGLETON HIGH SCHOOL
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515
Practice Address - Country:US
Practice Address - Phone:979-849-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT0431174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist