Provider Demographics
NPI:1336343763
Name:HORNE, SUSAN CHRISTINE (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CHRISTINE
Last Name:HORNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6553 E BAYWOOD AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-1752
Mailing Address - Country:US
Mailing Address - Phone:480-543-6750
Mailing Address - Fax:480-543-5907
Practice Address - Street 1:6553 E BAYWOOD AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1752
Practice Address - Country:US
Practice Address - Phone:480-543-6750
Practice Address - Fax:480-543-5907
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40385208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z123681Medicare PIN