Healthcare Provider Details

I. General information

NPI: 1891784369
Provider Name (Legal Business Name): MERRILL C HORNE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BERTHA HOWE AVE SUITE 1
MESQUITE NV
89027-7502
US

IV. Provider business mailing address

1301 BERTHA HOWE AVE SUITE 1
MESQUITE NV
89027-7502
US

V. Phone/Fax

Practice location:
  • Phone: 702-346-0800
  • Fax: 702-346-0801
Mailing address:
  • Phone: 702-346-0800
  • Fax: 702-346-0801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberD8273
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number9847
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: