Provider Demographics
NPI:1053489302
Name:HORTON, FREDERICK TRYON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:TRYON
Last Name:HORTON
Suffix:JR
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 1:2701 GLENWOOD GARDENS LN.
Mailing Address - Street 2:#301
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27608-8041
Mailing Address - Country:US
Mailing Address - Phone:919-720-4079
Mailing Address - Fax:
Practice Address - Street 1:314 E HARGETT ST
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27601-1436
Practice Address - Country:US
Practice Address - Phone:919-828-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97014062084P0800X, 2084P0804X, 2084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN002006459OtherBLUECROSSBLUESHIELD
TND70170Medicare UPIN
TN3159374Medicare ID - Type Unspecified