Provider Demographics
NPI:1265492508
Name:HORTON, JOHN ANDREW (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ANDREW
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 1:1240 WESTLAKE BLVD
Mailing Address - Street 2:SUITE 231
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-1929
Mailing Address - Country:US
Mailing Address - Phone:805-446-4444
Mailing Address - Fax:805-371-9239
Practice Address - Street 1:1240 WESTLAKE BLVD
Practice Address - Street 2:SUITE 231
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-1929
Practice Address - Country:US
Practice Address - Phone:805-446-4444
Practice Address - Fax:805-371-9239
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21176208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G21176OtherBLUE SHIELD
CA00G21176OtherBLUE SHIELD
CAF43115Medicare UPIN