Provider Demographics
NPI:1720018120
Name:VAN HORN, ALLAN CHAD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLAN
Middle Name:CHAD
Last Name:VAN 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:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:
Practice Address - Street 1:2705 PRINCE GEORGE AVE
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-2045
Practice Address - Country:US
Practice Address - Phone:972-780-0480
Practice Address - Fax:972-780-1453
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4762208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1344721009OtherCIGNA
TX340009464OtherRAIL ROAD MEDICARE
TXP01346795OtherRAILROAD MEDICARE
TX035084501Medicaid
TX001382060OtherUNITED HEALTH
TX035084502Medicaid
TX035084503Medicaid
TX8A9483OtherBLUECROSS BLUESHIELD
TX0614904OtherAETNA
TX0614904OtherAETNA
TX8F7382Medicare PIN
TX344768YM09Medicare PIN
TX035084501Medicaid