Healthcare Provider Details

I. General information

NPI: 1275648230
Provider Name (Legal Business Name): RANDY D HORN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41810 N VENTURE DR BUILDING C-120
ANTHEM AZ
85086-3169
US

IV. Provider business mailing address

8620 N 22ND AVE #200 VHS CLINICS
PHOENIX AZ
85021
US

V. Phone/Fax

Practice location:
  • Phone: 623-551-2516
  • Fax: 623-551-2475
Mailing address:
  • Phone: 602-674-6506
  • Fax: 602-674-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number3946
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: