Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 01023903A | IN |
NPI | 1245212141 |
---|---|
Provider Name | Dr. Douglas J. Horton |
First Address | Charlotte, NC 28260-3725 |
Second Address | Indianapolis, IN 46260-5349 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 07/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100064930 | (05) | IN |
IN1125006 | MEDICARE PTAN (01) | IN |
IN1126006 | MEDICARE PTAN (01) | IN |
IN1127006 | MEDICARE PTAN (01) | IL |
P00321196 | RAILROAD MEDICARE PIN (01) |