Provider Demographics
NPI:1073531257
Name:HORTON, SAMUEL (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
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 1:13000 N MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1404
Mailing Address - Country:US
Mailing Address - Phone:317-208-3855
Mailing Address - Fax:317-208-3847
Practice Address - Street 1:13000 N MERIDIAN ST # 101
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-1404
Practice Address - Country:US
Practice Address - Phone:317-208-3855
Practice Address - Fax:317-208-3847
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060857A2084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529260Medicaid
IN151560D4Medicare PIN
IN152410AAAMedicare PIN
IN254100EMedicare PIN
IN01060857AOtherSTATE MEDICAL LICENCE
IN160120YYMedicare PIN
INBH9343895OtherDEA NUMBER