Healthcare Provider Details

I. General information

NPI: 1245212141
Provider Name (Legal Business Name): DOUGLAS J. HORTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 07/07/2021
Certification Date: 07/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9002 N MERIDIAN ST STE 107
INDIANAPOLIS IN
46260-5349
US

IV. Provider business mailing address

PO BOX 603725
CHARLOTTE NC
28260-3725
US

V. Phone/Fax

Practice location:
  • Phone: 317-848-9441
  • Fax: 317-924-8239
Mailing address:
  • Phone: 828-575-2625
  • Fax: 828-350-2174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number01023903A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: