Provider Demographics
NPI:1801880687
Name:HORAN, WILLIAM JOHN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:HORAN
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 1:460 BURMA RD W
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:NC
Mailing Address - Zip Code:28752-5278
Mailing Address - Country:US
Mailing Address - Phone:828-318-3284
Mailing Address - Fax:
Practice Address - Street 1:220 NASH MEDICAL ARTS MALL
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-1470
Practice Address - Country:US
Practice Address - Phone:252-962-4550
Practice Address - Fax:252-962-4551
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2022-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9400274208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8944466Medicaid
NC44466Medicare ID - Type UnspecifiedPART A BCBS
NCA51134Medicare UPIN