Provider Demographics
NPI:1972534410
Name:OSSORIO, MIGUEL ANTONIO (MD)
Entity type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ANTONIO
Last Name:OSSORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1113 SOUTHWEST AVE
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-6517
Mailing Address - Country:US
Mailing Address - Phone:423-232-0624
Mailing Address - Fax:
Practice Address - Street 1:JAMES H.QUILLEN MEDICAL CENTER
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3476
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN29682207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease