Healthcare Provider Details

I. General information

NPI: 1336227354
Provider Name (Legal Business Name): LAWRENCE HORNICK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 SE 8TH AVE
HILLSBORO OR
97123-4246
US

IV. Provider business mailing address

PO BOX 28130
PORTLAND OR
97228-8130
US

V. Phone/Fax

Practice location:
  • Phone: 503-681-1106
  • Fax: 503-681-1796
Mailing address:
  • Phone: 503-681-1009
  • Fax: 503-681-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD09467
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD09467
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: