Provider Demographics
NPI:1700809555
Name:OSBORNE, ISAAC JT (MD)
Entity Type:Individual
Prefix:DR
First Name:ISAAC
Middle Name:JT
Last Name:OSBORNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 VICTORIA LN STE 12
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3228
Mailing Address - Country:US
Mailing Address - Phone:903-577-9991
Mailing Address - Fax:
Practice Address - Street 1:512 VICTORIA LN STE 12
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3228
Practice Address - Country:US
Practice Address - Phone:903-577-9991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4196174400000X, 207R00000X
KY33820207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX150990301Medicaid
TX0010HZOtherBCBS
TX8203B6Medicare PIN
TXTXB138748Medicare Oscar/Certification