MEDICARE: DR. MALCOLM HORNE JR. M D

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	207R00000X	Internal Medicine Physician	E5790	TX

General Provider Information

NPI Number	:	1811005556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MALCOLM HORNE JR. M D

Provider Business Mailing Address
First Line	:	12541 DEGAS LANE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230
Country	:	US
Telephone Number	:	972-386-9208
Fax Number	:

Provider Business Practice Location Address
First Line	:	12541 DEGAS LN
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75230-1751
Country	:	US
Telephone Number	:	972-386-9208
Fax Number	:

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

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	07/08/2007

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