Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 4000 | AL |
NPI | 1124132139 |
---|---|
Provider Name | Dr. Killian Joseph Horner |
First Address | Montgomery, AL 36117-3498 |
Second Address | Montgomery, AL 36117-3498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
816933 | UNITED CONCORDIA (01) | |
90188 | BCBS (01) | AL |