Provider Demographics
NPI:1972514412
Name:HORTON, JANE TRACY (MD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:TRACY
Last Name:HORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 W. WASHINGTON ST., WASHINGTON AND LEE UNIVERSITY
Mailing Address - Street 2:STUDENT HEALTH CENTER
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2116
Mailing Address - Country:US
Mailing Address - Phone:540-458-8401
Mailing Address - Fax:540-458-8404
Practice Address - Street 1:204 W. WASHINGTON ST., WASHINGTON AND LEE UNIVERSITY
Practice Address - Street 2:STUDENT HEALTH CENTER
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450-2116
Practice Address - Country:US
Practice Address - Phone:540-458-8401
Practice Address - Fax:540-458-8404
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101038837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101038837OtherSTATE MEDICAL LICENSE
VA05002831106OtherME NUMBER
VAE19158Medicare UPIN