Healthcare Provider Details

I. General information

NPI: 1629028873
Provider Name (Legal Business Name): RICHARD HORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

IV. Provider business mailing address

101 BODIN CIR
TRAVIS AFB CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3330
  • Fax: 707-423-7382
Mailing address:
  • Phone: 707-423-3330
  • Fax: 707-423-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number8545
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: