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NPI Code Detail

MEDICARE: LAUREN LYNN HORNELL MD

MEDICARE:   LAUREN LYNN HORNELL  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianL1615TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00277158OTHERMEDICARE RR

General Provider Information

NPI Number : 1235167586
Entity Type Code : Individual
Provider Name (Legal Business Name) : LAUREN LYNN HORNELL MD
Provider Business Mailing Address
First Line : PO BOX 9477
Second Line :
City : TYLER
State : TX
Zip : 75711-9477
Country : US
Telephone Number : 903-594-2450
Fax Number : 903-509-0493
Provider Business Practice Location Address
First Line : 6210 S BROADWAY AVE
Second Line :
City : TYLER
State : TX
Zip : 75703-4413
Country : US
Telephone Number : 903-579-2700
Fax Number : 903-579-2799
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2006
Last Update Date : 11/02/2007

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