Healthcare Provider Details

I. General information

NPI: 1780604587
Provider Name (Legal Business Name): DONALD L HORNEY, MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1332 S COUNTRY CLUB DR
GALLUP NM
87301-5665
US

IV. Provider business mailing address

PO BOX 218
GALLUP NM
87305-0218
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-2134
  • Fax: 505-863-8900
Mailing address:
  • Phone: 505-870-0640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number91-222
License Number StateNM

VIII. Authorized Official

Name: DONALD L HORNEY
Title or Position: PRESIDENT
Credential: PH.D., M.D.
Phone: 505-870-0640