Healthcare Provider Details

I. General information

NPI: 1679567531
Provider Name (Legal Business Name): JOHN FX HORAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 03/07/2022
Certification Date: 03/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 CENTERVILLE RD
WARWICK RI
02886-4347
US

IV. Provider business mailing address

1592 BROAD ST
CRANSTON RI
02905-4130
US

V. Phone/Fax

Practice location:
  • Phone: 401-606-2680
  • Fax:
Mailing address:
  • Phone: 401-467-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDO00320
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: