Healthcare Provider Details

I. General information

NPI: 1427012210
Provider Name (Legal Business Name): RANDALL EARL HORTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 BETHIA ST
FRANKLIN LA
70538
US

IV. Provider business mailing address

1501 BETHIA ST
FRANKLIN LA
70538-3720
US

V. Phone/Fax

Practice location:
  • Phone: 337-828-3507
  • Fax: 337-828-7204
Mailing address:
  • Phone: 337-828-3507
  • Fax: 337-828-7204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number04557R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: