Provider Demographics
NPI:1952524415
Name:HORRES, ERNEST GLENN JR (MD)
Entity type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:GLENN
Last Name:HORRES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:669 SAINT ANDREWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-7165
Mailing Address - Country:US
Mailing Address - Phone:843-402-0797
Mailing Address - Fax:843-556-0300
Practice Address - Street 1:669 SAINT ANDREWS BLVD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-7165
Practice Address - Country:US
Practice Address - Phone:843-402-0797
Practice Address - Fax:843-556-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC168182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC168188 GP2153Medicaid