MEDICARE: ALLEN BRUCE HORNELL MD

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	207Q00000X	Family Medicine Physician	K2042	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8CN892	OTHER	TX	BCBSTX

General Provider Information

NPI Number	:	1366470247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN BRUCE HORNELL MD

Provider Business Mailing Address
First Line	:	5450 CLEARFORK MAIN ST STE 430
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3559
Country	:	US
Telephone Number	:	817-984-1688
Fax Number	:	817-419-4494

Provider Business Practice Location Address
First Line	:	5450 CLEARFORK MAIN ST STE 430
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76109-3559
Country	:	US
Telephone Number	:	817-984-1688
Fax Number	:	817-419-4494

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

Provider Enumeration Date	:	06/29/2006
Last Update Date	:	11/25/2019

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Directions to “ ALLEN BRUCE HORNELL MD” Practice Location

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