Healthcare Provider Details

I. General information

NPI: 1528036043
Provider Name (Legal Business Name): BRIAN D HORNBACK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2006
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2560 N SHADELAND AVE STE A
INDIANAPOLIS IN
46219-1706
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 800-890-6220
  • Fax: 317-275-8018
Mailing address:
  • Phone: 606-886-8511
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number36371
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: