Healthcare Provider Details

I. General information

NPI: 1538157102
Provider Name (Legal Business Name): ROBERT RAYMOND HORANZY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 S 3RD ST
DAVIS OK
73030-2305
US

IV. Provider business mailing address

RR 2 BOX 396
SULPHUR OK
73086-9674
US

V. Phone/Fax

Practice location:
  • Phone: 580-369-2803
  • Fax:
Mailing address:
  • Phone: 580-622-2279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20039
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: