Provider Demographics
NPI:1467432880
Name:HORTON, DIANA (MD)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:HORTON
Suffix:
Gender:F
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 160787
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78716-0787
Mailing Address - Country:US
Mailing Address - Phone:512-445-9000
Mailing Address - Fax:512-306-8788
Practice Address - Street 1:4207 JAMES CASEY ST
Practice Address - Street 2:SUITE 302
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-3300
Practice Address - Country:US
Practice Address - Phone:512-445-9000
Practice Address - Fax:512-306-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0002207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0045KDOtherBCBS
P00004533OtherRAILROAD MEDICARE
P00004533OtherRAILROAD MEDICARE
E97702Medicare UPIN