Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G68161 | CA |
NPI | 1194781005 |
---|---|
Provider Name | Dr. Thomas John Horn |
First Address | Ventura, CA 93003-7844 |
Second Address | Ventura, CA 93003-3165 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 27/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BH0913649 | DEA (01) | CA |
E82303 | (02) | CA |
G68161 | STATE LICENSE (01) | CA |