Provider Demographics
NPI:1659371128
Name:HORN, GREGORY WADE (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:WADE
Last Name:HORN
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 1:21 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5709
Mailing Address - Country:US
Mailing Address - Phone:228-818-0717
Mailing Address - Fax:228-872-8575
Practice Address - Street 1:21 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5709
Practice Address - Country:US
Practice Address - Phone:228-872-1505
Practice Address - Fax:228-872-8575
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS15343207V00000X
LA021971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00118187Medicaid
MS160048497OtherMEDICARE RAILROAD
MS7430044OtherUHC PPO NUMBER
MS721345420OtherCOMMERCIAL PAYORS NUMBER
MS5916558OtherAETNA PPO NUMBER
MSG49162Medicare UPIN
MS160048497OtherMEDICARE RAILROAD