Provider Demographics
NPI:1861476558
Name:HORTON, SAM LEBARRE (MD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:LEBARRE
Last Name:HORTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1904 W 4TH ST S
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-4703
Mailing Address - Country:US
Mailing Address - Phone:918-343-5106
Mailing Address - Fax:918-343-5107
Practice Address - Street 1:1904 W 4TH ST S
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-4703
Practice Address - Country:US
Practice Address - Phone:918-343-5106
Practice Address - Fax:918-343-5107
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-06
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22025208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKH45106Medicare UPIN