Provider Demographics
NPI:1972508299
Name:OSSI, PAUL B (MD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:B
Last Name:OSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:10881 SAN JOSE BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-6612
Mailing Address - Country:US
Mailing Address - Phone:904-880-5522
Mailing Address - Fax:904-880-5533
Practice Address - Street 1:10881 SAN JOSE BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-6612
Practice Address - Country:US
Practice Address - Phone:904-387-9525
Practice Address - Fax:904-389-8478
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME695042085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL28754OtherWELLCARE
FL258471OtherAVMED
FL655587300OtherCIGNA
FL256888800Medicaid
FL3600145OtherUNITED HEALTHCARE
FL4099572OtherG H I
FL920005146OtherRAILROAD MEDICARE
GA00965566AMedicaid
FL28753OtherHEALTHEASE
FL3600145OtherUNITED HEALTHCARE
FL256888800Medicaid