Provider Demographics
NPI:1992230429
Name:OSORIO, GEORGE WILLIAMS (IDC)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:WILLIAMS
Last Name:OSORIO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 FOREST LAKES CIR APT D
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5773
Mailing Address - Country:US
Mailing Address - Phone:561-319-5412
Mailing Address - Fax:
Practice Address - Street 1:1734 FOREST LAKES CIR APT D
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-5773
Practice Address - Country:US
Practice Address - Phone:561-319-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLO2603198937201710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman