Provider Demographics
NPI:1376528190
Name:HORTON, CARL JR (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:
Last Name:HORTON
Suffix:JR
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 1:203 WALLS DR STE 204
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7029
Mailing Address - Country:US
Mailing Address - Phone:817-556-9190
Mailing Address - Fax:
Practice Address - Street 1:203 WALLS DR STE 204
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7029
Practice Address - Country:US
Practice Address - Phone:817-556-9190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL8374207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX165878305Medicaid
TXI04587Medicare UPIN
TX477099YKPWMedicare PIN
TX165878305Medicaid
TX477099YKP5Medicare PIN