Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3483 | WV |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 20528 | WV |
NPI | 1417911975 |
---|---|
Provider Name | Dr. Bruce Brian Horswell |
First Address | Charleston, WV 25302-3390 |
Second Address | Charleston, WV 25302-3302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 21/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
190009986 | RAILROAD MEDICARE (01) | |
3002311000 | (05) | WV |
4002072000 | (05) | WV |
F84009 | (02) |