Healthcare Provider Details

I. General information

NPI: 1033123492
Provider Name (Legal Business Name): LAWRENCE B HORTON D.O.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2616 MESILLA ST NE SUITE 2
ALBUQUERQUE NM
87110-3686
US

IV. Provider business mailing address

2616 MESILLA ST NE SUITE 2
ALBUQUERQUE NM
87110-3686
US

V. Phone/Fax

Practice location:
  • Phone: 505-266-5681
  • Fax: 505-266-2923
Mailing address:
  • Phone: 505-266-5681
  • Fax: 505-266-2923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number351RX2
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: