Provider Demographics
NPI:1326775230
Name:OSORIO, WDSVING A (MD)
Entity type:Individual
Prefix:DR
First Name:WDSVING
Middle Name:A
Last Name:OSORIO
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 1:3987 ARIVA LOOP APT 308
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33812-4460
Mailing Address - Country:US
Mailing Address - Phone:862-232-6022
Mailing Address - Fax:
Practice Address - Street 1:5035 E BUSCH BLVD # 1AB
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-5310
Practice Address - Country:US
Practice Address - Phone:813-538-7880
Practice Address - Fax:813-988-4401
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1507208D00000X
PR22898207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty