Healthcare Provider Details

I. General information

NPI: 1780899799
Provider Name (Legal Business Name): JOHN ALLAN HORNELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ALLAN HORNELL MD

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 05/21/2021
Certification Date: 05/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9605 SANDIFUR PKWY
PASCO WA
99301-8028
US

IV. Provider business mailing address

3900 S ZINTEL WAY
KENNEWICK WA
99338
US

V. Phone/Fax

Practice location:
  • Phone: 509-942-3170
  • Fax: 509-543-9795
Mailing address:
  • Phone: 509-942-3627
  • Fax: 509-942-2268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD60201679
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: