Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | R1278 | KY |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 257503-1 | NY |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | TL33789 | SC |
NPI | 1659535706 |
---|---|
Provider Name | Dr. Michael Patrick Horan |
First Address | Boston, MA 02284-8932 |
Second Address | Columbia, SC 29203-6877 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2008 |
Last Update Date | 14/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33789 | LICENSE (01) | SC |
337898 | (05) | SC |