Provider Demographics
NPI:1780604587
Name:DONALD L HORNEY, MD, PC
Entity type:Organization
Organization Name:DONALD L HORNEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:L
Authorized Official - Last Name:HORNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MD
Authorized Official - Phone:505-870-0640
Mailing Address - Street 1:PO BOX 218
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87305-0218
Mailing Address - Country:US
Mailing Address - Phone:505-870-0640
Mailing Address - Fax:
Practice Address - Street 1:1332 S COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5665
Practice Address - Country:US
Practice Address - Phone:505-863-2134
Practice Address - Fax:505-863-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM91-222174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NME1393Medicaid
AZ327909Medicaid
NM00NM009587OtherBCBS
AZ327909Medicaid
NME1393Medicaid