Provider Demographics
NPI:1275301723
Name:HORTON, DAVID RYDER
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:RYDER
Last Name:HORTON
Suffix:
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:PO BOX 745
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHNSBURY
Mailing Address - State:VT
Mailing Address - Zip Code:05819-0745
Mailing Address - Country:US
Mailing Address - Phone:802-274-6336
Mailing Address - Fax:
Practice Address - Street 1:17 CHURCH ST APT 25
Practice Address - Street 2:
Practice Address - City:SAINT JOHNSBURY
Practice Address - State:VT
Practice Address - Zip Code:05819-2198
Practice Address - Country:US
Practice Address - Phone:802-274-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-14
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist