Provider Demographics
NPI:1073531257
Name:HORTON, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:HORTON
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 1:3743 LANDMARK DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-6656
Mailing Address - Country:US
Mailing Address - Phone:765-448-4511
Mailing Address - Fax:765-447-8375
Practice Address - Street 1:3743 LANDMARK DR STE 200
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-6656
Practice Address - Country:US
Practice Address - Phone:765-448-4511
Practice Address - Fax:765-447-8375
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060857A2084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529260Medicaid
IN151560D4Medicare PIN
IN152410AAAMedicare PIN
IN254100EMedicare PIN
IN01060857AOtherSTATE MEDICAL LICENCE
IN160120YYMedicare PIN
INBH9343895OtherDEA NUMBER