Provider Demographics
NPI:1083999668
Name:HORNSBY, BERNARD MADISON JR
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:MADISON
Last Name:HORNSBY
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 YUKON DR
Mailing Address - Street 2:
Mailing Address - City:GLENN HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:75154-8827
Mailing Address - Country:US
Mailing Address - Phone:469-658-2641
Mailing Address - Fax:
Practice Address - Street 1:1208 YUKON DR
Practice Address - Street 2:
Practice Address - City:GLENN HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:75154-8827
Practice Address - Country:US
Practice Address - Phone:469-658-2641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker