MEDICARE: ROBERT RAYMOND HORANZY 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	207Q00000X	Family Medicine Physician	20039	OK

General Provider Information

NPI Number	:	1538157102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT RAYMOND HORANZY M.D.

Provider Business Mailing Address
First Line	:	RR 2 BOX 396
Second Line	:
City	:	SULPHUR
State	:	OK
Zip	:	73086-9674
Country	:	US
Telephone Number	:	580-622-2279
Fax Number	:

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	:

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

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	07/08/2007

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1497748180 — BURFORD MANOR
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