Provider Demographics
NPI:1891469805
Name:HORNER, SEAN B
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:B
Last Name:HORNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 LOS LOVATOS RD
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87501-1248
Mailing Address - Country:US
Mailing Address - Phone:303-519-4816
Mailing Address - Fax:
Practice Address - Street 1:1850 CALLE MEDICO STE H
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4828
Practice Address - Country:US
Practice Address - Phone:303-519-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT54992081S0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports Medicine