Provider Demographics
NPI:1336179399
Name:OSBON, TIMOTHY BARTON (MD, MS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:BARTON
Last Name:OSBON
Suffix:
Gender:M
Credentials:MD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1156 BOWMAN RD UNIT 103
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3803
Mailing Address - Country:US
Mailing Address - Phone:843-654-7337
Mailing Address - Fax:
Practice Address - Street 1:1156 BOWMAN RD UNIT 103
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3803
Practice Address - Country:US
Practice Address - Phone:843-654-7337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2014-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25298207P00000X, 207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC252988Medicaid
I39898Medicare UPIN
SC252988Medicaid
SCP00249768Medicare PIN
SCAA10612987Medicare PIN