Provider Demographics
NPI:1891904827
Name:HORTON, THOMAS RUSSELL JR (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RUSSELL
Last Name:HORTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:T.
Other - Middle Name:RUSSELL
Other - Last Name:HORTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1726 POPLAR AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-6426
Mailing Address - Country:US
Mailing Address - Phone:901-274-3550
Mailing Address - Fax:
Practice Address - Street 1:1726 POPLAR AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-6426
Practice Address - Country:US
Practice Address - Phone:901-274-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-3656207V00000X
TNMD0000036459207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H68350Medicare UPIN