Provider Demographics
NPI:1013994367
Name:OSBORN, JEANNE PRUSS (MD)
Entity Type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:PRUSS
Last Name:OSBORN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JEANNE
Other - Middle Name:ELIZABETH
Other - Last Name:PRUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:19470 KERSHAW CT
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-2894
Mailing Address - Country:US
Mailing Address - Phone:719-487-3237
Mailing Address - Fax:
Practice Address - Street 1:8890 N UNION BLVD
Practice Address - Street 2:SUITE 207
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7799
Practice Address - Country:US
Practice Address - Phone:719-667-0888
Practice Address - Fax:719-667-0808
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2015-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43770207N00000X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA104343Medicare UPIN