Provider Demographics
NPI:1609801521
Name:HORN, GORDON J (PHD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:J
Last Name:HORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 N MAITLAND AVE STE 135
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4759
Mailing Address - Country:US
Mailing Address - Phone:407-592-9913
Mailing Address - Fax:407-386-6085
Practice Address - Street 1:341 N MAITLAND AVE STE 135
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751
Practice Address - Country:US
Practice Address - Phone:407-592-9913
Practice Address - Fax:407-386-6085
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2252103G00000X
FLPY5700103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
680009516OtherRAILROAD MEDICARE
FL54227OtherBCBS