Provider Demographics
NPI:1184600421
Name:HORTON, DAN D (MD)
Entity type:Individual
Prefix:MR
First Name:DAN
Middle Name:D
Last Name:HORTON
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 1:4417 WEST GORE BLVD.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-5978
Mailing Address - Country:US
Mailing Address - Phone:580-353-3920
Mailing Address - Fax:580-353-3936
Practice Address - Street 1:4417 WEST GORE BLVD.
Practice Address - Street 2:SUITE 6
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-5978
Practice Address - Country:US
Practice Address - Phone:580-353-3920
Practice Address - Fax:580-353-3936
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10253207Q00000X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100089340AMedicaid
OK100089340AMedicaid
OKD34819Medicare UPIN