Provider Demographics
NPI:1952389900
Name:HORTON, BRUCE DAVID (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DAVID
Last Name:HORTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:16246 PRINCE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH HOLLAND
Mailing Address - State:IL
Mailing Address - Zip Code:60473-3233
Mailing Address - Country:US
Mailing Address - Phone:708-333-4200
Mailing Address - Fax:708-333-8585
Practice Address - Street 1:16246 PRINCE DR
Practice Address - Street 2:
Practice Address - City:SOUTH HOLLAND
Practice Address - State:IL
Practice Address - Zip Code:60473-3233
Practice Address - Country:US
Practice Address - Phone:708-333-4200
Practice Address - Fax:708-333-8585
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1623863OtherBCBS
IL1623863OtherBCBS
D89607Medicare UPIN