Provider Demographics
NPI:1679557284
Name:HORNER, MOLLY L (MD)
Entity Type:Individual
Prefix:DR
First Name:MOLLY
Middle Name:L
Last Name:HORNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MOLLY
Other - Middle Name:L
Other - Last Name:YARDLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 110429
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80042-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12605 E 16TH AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2545
Practice Address - Country:US
Practice Address - Phone:720-848-0000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39521207V00000X
WAMD61269576207V00000X
COCDRH.0039521208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO021727OtherKAISER COMMERCIAL NUMBER
CO08787727Medicaid
H39760Medicare UPIN
CO021727OtherKAISER COMMERCIAL NUMBER
COCOA106153Medicare PIN