MEDICARE: DR. DOUGLAS J. HORTON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207K00000X	Allergy & Immunology Physician	01023903A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	IN1126006	OTHER	IN	MEDICARE PTAN
2	IN1127006	OTHER	IL	MEDICARE PTAN
4	IN1125006	OTHER	IN	MEDICARE PTAN
5	P00321196	OTHER		RAILROAD MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245212141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS J. HORTON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 603725
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-3725
Country	:	US
Telephone Number	:	828-575-2625
Fax Number	:	828-350-2174

Provider Business Practice Location Address
First Line	:	9002 N MERIDIAN ST STE 107
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-5349
Country	:	US
Telephone Number	:	317-848-9441
Fax Number	:	317-924-8239

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	07/07/2021

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Directions to “ DR. DOUGLAS J. HORTON M.D.” Practice Location

Language	Start Address	Practice Location

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