=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811903842
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GREGG A HORRAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2006
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 MARSH ST
-----------------------------------------------------
City | MANKATO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56001-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-594-4863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 MARSH ST
-----------------------------------------------------
City | MANKATO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 56001-4752
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 507-594-4863
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 43850-20
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 49152
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | 73822
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------