MEDICARE: MITCHELL F HORAN 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	32379	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8EE795	OTHER	TX	MEDICARE PTAN

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

General Provider Information

NPI Number	:	1952388449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL F HORAN MD

Provider Business Mailing Address
First Line	:	PO BOX 130
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-9217
Fax Number	:	907-842-9250

Provider Business Practice Location Address
First Line	:	6000 KANAKANK
Second Line	:
City	:	DILLINGHAM
State	:	AK
Zip	:	99576-0130
Country	:	US
Telephone Number	:	907-842-9217
Fax Number	:	907-842-9250

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	04/26/2021

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Directions to “ MITCHELL F HORAN MD” Practice Location

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