Provider Demographics
NPI:1417020942
Name:HORSLEY, ANDREW P (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:P
Last Name:HORSLEY
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:160 GREEN VALLEY RD STE 101
Practice Address - Street 2:
Practice Address - City:FREEDOM
Practice Address - State:CA
Practice Address - Zip Code:95019-3160
Practice Address - Country:US
Practice Address - Phone:209-956-7732
Practice Address - Fax:831-763-9799
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73934207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A739340Medicare ID - Type Unspecified
CAH92011Medicare UPIN
CACA118542Medicare PIN