Provider Demographics
NPI:1730113366
Name:HORN, JOSEPH ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ROBERT
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 1:1707 NORTH MAIN STREET
Mailing Address - Street 2:404
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501
Mailing Address - Country:US
Mailing Address - Phone:303-776-4949
Mailing Address - Fax:303-776-7693
Practice Address - Street 1:1707 MAIN ST
Practice Address - Street 2:404
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-7407
Practice Address - Country:US
Practice Address - Phone:303-776-4949
Practice Address - Fax:303-776-7693
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO254242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO43211Medicare ID - Type Unspecified