MEDICARE: REEGAN HORTON

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
1	390200000X	Student in an Organized Health Care Education/Training Program		AZ

General Provider Information

NPI Number	:	1619713955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REEGAN HORTON

Provider Business Mailing Address
First Line	:	3777 E MCDOWELL RD
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85008-4336
Country	:	US
Telephone Number	:	509-720-3922
Fax Number	:

Provider Business Practice Location Address
First Line	:	850 N 5TH ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85004-2289
Country	:	US
Telephone Number	:	923-523-5511
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2024
Last Update Date	:	07/05/2024

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Directions to “ REEGAN HORTON ” Practice Location

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