Provider Demographics
NPI:1871570259
Name:HORTON, DAVID F (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:HORTON
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 1:4525 3RD AVE SE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1010
Mailing Address - Country:US
Mailing Address - Phone:360-412-8960
Mailing Address - Fax:360-412-8974
Practice Address - Street 1:4525 3RD AVE SE
Practice Address - Street 2:SUITE 100
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1010
Practice Address - Country:US
Practice Address - Phone:360-412-8960
Practice Address - Fax:360-412-8974
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00026181174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8130221Medicaid
WAGAB12952Medicare ID - Type Unspecified
WAE71823Medicare UPIN