Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2084N0400X | Neurologist | ME61926 | FL |
NPI | 1023092681 |
---|---|
Provider Name | Larry Wayne Horton |
First Address | Palm Harbor, FL 34685-3494 |
Second Address | Palm Harbor, FL 34685-3494 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 05/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
370538200 | (05) | FL |
AL246 | MEDICARE PTAN (01) | FL |
F25171 | (02) | FL |