Provider Demographics
NPI:1275648230
Name:HORN, RANDY D (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDY
Middle Name:D
Last Name:HORN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:8620 N 22ND AVE #200
Mailing Address - Street 2:VHS CLINICS
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021
Mailing Address - Country:US
Mailing Address - Phone:602-674-6506
Mailing Address - Fax:602-674-6512
Practice Address - Street 1:41810 N VENTURE DR
Practice Address - Street 2:BUILDING C-120
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-3169
Practice Address - Country:US
Practice Address - Phone:623-551-2516
Practice Address - Fax:623-551-2475
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2009-08-05
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Provider Licenses
StateLicense IDTaxonomies
AZ3946207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ809262Medicaid
AZ809262Medicaid
AZH26159Medicare UPIN