Provider Demographics
NPI:1003807231
Name:HORMAN, DERON L (MD)
Entity Type:Individual
Prefix:DR
First Name:DERON
Middle Name:L
Last Name:HORMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 N MAIN ST STE 1100
Mailing Address - Street 2:
Mailing Address - City:BELLEFONTAINE
Mailing Address - State:OH
Mailing Address - Zip Code:43311-2379
Mailing Address - Country:US
Mailing Address - Phone:937-651-6820
Mailing Address - Fax:937-651-6822
Practice Address - Street 1:1134 N MAIN ST STE 1100
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311
Practice Address - Country:US
Practice Address - Phone:937-651-6820
Practice Address - Fax:937-651-6822
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-05
Last Update Date:2018-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35067435H207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00386660OtherRR MEDICARE
OH2055430Medicaid
OHHO0773926Medicare PIN
OH2055430Medicaid