MEDICARE: DR. JAMAL HORANI 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
1	174400000X	Specialist	5789191	UT

General Provider Information

NPI Number	:	1770585564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMAL HORANI MD

Provider Business Mailing Address
First Line	:	PO BOX 9519
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84409-0519
Country	:	US
Telephone Number	:	801-475-5950
Fax Number	:	801-475-7322

Provider Business Practice Location Address
First Line	:	5315 ADAMS AVE
Second Line	:	SUITE A
City	:	WASHINGTON TERRACE
State	:	UT
Zip	:	84405-1193
Country	:	US
Telephone Number	:	801-475-7707
Fax Number	:	801-475-7322

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	02/06/2009

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