Healthcare Provider Details

I. General information

NPI: 1497750392
Provider Name (Legal Business Name): ALBERT B HORN III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2005
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 WEST 38TH STREET BUILDING F
AUSTIN TX
78705-1133
US

IV. Provider business mailing address

711-F WEST 38TH STREET
AUSTIN TX
78705-1133
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-6121
  • Fax: 512-452-9171
Mailing address:
  • Phone: 512-458-6121
  • Fax: 512-452-9171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberE6100
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: