Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 35067435H | OH |
NPI | 1003807231 |
---|---|
Provider Name | Dr. Deron L Horman |
First Address | Bellefontaine, OH 43311-2379 |
Second Address | Bellefontaine, OH 43311 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2005 |
Last Update Date | 24/05/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2055430 | (05) | OH |
F93273 | (02) | OH |
P00386660 | RR MEDICARE (01) | OH |