Individual
JONATHAN VAUGHN OSBORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9401 HOLY CROSS LN, SUITE 112, BREESE, IL 62230-3510
(618) 526-7271
(618) 526-7313
Mailing address
9401 HOLY CROSS LN, SUITE 112, BREESE, IL 62230-3510
(618) 526-7271
(618) 526-7313
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036058834
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036058834
—
IL
Enumeration date
08/30/2006
Last updated
09/10/2010
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