Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0129X | Vascular Surgeon | C0007743 | MD |
NPI | 1114558491 |
---|---|
Provider Name | Colby Rhel Horton |
First Address | Hagerstown, MD 21742 |
Second Address | Hagerstown, MD 21742-6799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/01/2020 |
Last Update Date | 05/08/2021 |