Healthcare Provider Details

I. General information

NPI: 1922474006
Provider Name (Legal Business Name): DR. JACOB MATTHEW HORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 PEACH ST
ERIE PA
16509-2603
US

IV. Provider business mailing address

13385 COUNTY ROAD 7
DELTA OH
43515-9733
US

V. Phone/Fax

Practice location:
  • Phone: 814-864-4031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberOT016812
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: