Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223P0106X | Oral and Maxillofacial Pathology | 38429 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 38429 | CA |
NPI | 1871526764 |
---|---|
Provider Name | Dr. Gerald D. Horner |
First Address | San Diego, CA 92130-4850 |
Second Address | San Diego, CA 92130-4850 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2006 |
Last Update Date | 13/07/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
112162 | MEDICARE ID (01) | CA |
U65158 | (02) | CA |