Healthcare Provider Details

I. General information

NPI: 1982910717
Provider Name (Legal Business Name): ROBERT M HORTON MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3124 BLUE RIDGE RD SUITE #101
RALEIGH NC
27612-8041
US

IV. Provider business mailing address

3124 BLUE RIDGE RD SUITE #101
RALEIGH NC
27612-8041
US

V. Phone/Fax

Practice location:
  • Phone: 919-782-2333
  • Fax: 919-787-5269
Mailing address:
  • Phone: 919-782-2333
  • Fax: 919-787-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number19169
License Number StateNC

VIII. Authorized Official

Name: ROBERT MARSHALL HORTON
Title or Position: OWNER
Credential: M.D.
Phone: 919-782-2333