Provider Demographics
NPI:1932205275
Name:HORN, ERICH PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:PAUL
Last Name:HORN
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 1:491 30TH ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-836-2122
Mailing Address - Fax:510-836-3773
Practice Address - Street 1:491 30TH ST
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-836-2122
Practice Address - Fax:510-836-3773
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2017-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60783207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A607830Medicaid
FL021124600Medicaid
180041718OtherRAILROAD MEDICARE
CA00A607830Medicaid
4910300001Medicare NSC
180041718OtherRAILROAD MEDICARE