Provider Demographics
NPI:1144200569
Name:HORNER, CATHERINE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:RUTH
Last Name:HORNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2297 MONTBROOK PLACE
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162
Mailing Address - Country:US
Mailing Address - Phone:410-430-7985
Mailing Address - Fax:
Practice Address - Street 1:1400 N US HIGHWAY 441
Practice Address - Street 2:NORTH SUITE 531
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-8975
Practice Address - Country:US
Practice Address - Phone:352-674-1720
Practice Address - Fax:352-750-5180
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0045005207Q00000X
FLME104172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD890001900Medicaid
MD890001900Medicaid
MD917MJ093Medicare ID - Type Unspecified