MEDICARE: ROBERT R. HORANZY M.D. LLC

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	20039	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	168463590-001	OTHER	OK	BLUECROSS

General Provider Information

NPI Number	:	1427154822
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT R. HORANZY M.D. LLC

Provider Business Mailing Address
First Line	:	RR 2 BOX 396
Second Line	:
City	:	SULPHUR
State	:	OK
Zip	:	73086-9674
Country	:	US
Telephone Number	:	580-369-2803
Fax Number	:	580-369-3497

Provider Business Practice Location Address
First Line	:	107 S 3RD ST
Second Line	:
City	:	DAVIS
State	:	OK
Zip	:	73030-2305
Country	:	US
Telephone Number	:	580-369-2803
Fax Number	:	580-369-3497

Authorized Official
Title or Position	:	PLLC
Name	:	DR. ROBERT RAYMOND HORANZY
Credential	:	M.D.
Telephone Number	:	580-369-2803

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	08/22/2020

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