Provider Demographics
NPI:1033123492
Name:HORTON, LAWRENCE B (DOM)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:B
Last Name:HORTON
Suffix:
Gender:M
Credentials:DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2616 MESILLA ST NE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3686
Mailing Address - Country:US
Mailing Address - Phone:505-266-5681
Mailing Address - Fax:505-266-2923
Practice Address - Street 1:2616 MESILLA ST NE
Practice Address - Street 2:SUITE 2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3686
Practice Address - Country:US
Practice Address - Phone:505-266-5681
Practice Address - Fax:505-266-2923
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM351RX2171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00R94ROtherBCBS PROVIDER #