Provider Demographics
NPI:1710962972
Name:HORTON, KEVIN BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:BRUCE
Last Name:HORTON
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 1:1202 E SONTERRA BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4091
Mailing Address - Country:US
Mailing Address - Phone:210-469-3790
Mailing Address - Fax:210-469-3794
Practice Address - Street 1:1202 E SONTERRA BLVD STE 401
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4091
Practice Address - Country:US
Practice Address - Phone:210-542-1212
Practice Address - Fax:210-469-3794
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3478207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DL473OtherBCBSTX
TXP01188779OtherRAILROAD MEDICARE
TX097452907Medicaid
TXB161141Medicare PIN
TX8639J0Medicare ID - Type Unspecified
TX8DL473OtherBCBSTX
TX8F9120Medicare PIN
TX1433997-01Medicaid
TX0974529-04Medicaid
TX0974552905Medicaid