Provider Demographics
NPI:1568590784
Name:DAN HORTON, M.D., INC.
Entity Type:Organization
Organization Name:DAN HORTON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-353-3920
Mailing Address - Street 1:4417 W GORE BLVD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5978
Mailing Address - Country:US
Mailing Address - Phone:580-353-3920
Mailing Address - Fax:580-353-3936
Practice Address - Street 1:4417 W GORE BLVD
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5978
Practice Address - Country:US
Practice Address - Phone:580-353-3920
Practice Address - Fax:580-353-3936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10253261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK731026014-001OtherBCBS BILLING NUMBER
OK100089340AMedicaid
OK100089340AMedicaid
OKD34819Medicare UPIN