Provider Demographics
NPI:1609939875
Name:HORGAN, PATRICK WARREN
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:WARREN
Last Name:HORGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7795 VIA MONTEBELLO
Mailing Address - Street 2:UNIT 2
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-5142
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2ND BATALLION 3RD MARINES
Practice Address - Street 2:
Practice Address - City:KANEOHE BAY
Practice Address - State:HI
Practice Address - Zip Code:96863-3006
Practice Address - Country:US
Practice Address - Phone:808-257-1789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman