Provider Demographics
NPI:1538106778
Name:HORNBACK, CLIFFORD F (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:F
Last Name:HORNBACK
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 1:1702 LAFAYETTE ROAD
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933
Mailing Address - Country:US
Mailing Address - Phone:765-362-4400
Mailing Address - Fax:765-364-1797
Practice Address - Street 1:1702 LAFAYETTE ROAD
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933
Practice Address - Country:US
Practice Address - Phone:765-362-4400
Practice Address - Fax:765-364-1797
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036782A207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
152750Medicare ID - Type Unspecified
C25373Medicare UPIN