Provider Demographics
NPI:1215986948
Name:HORNER, JOSEPH DOUGLAS (DO)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DOUGLAS
Last Name:HORNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3600 MINNESOTA DR
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-7979
Mailing Address - Country:US
Mailing Address - Phone:952-595-1100
Mailing Address - Fax:612-294-4903
Practice Address - Street 1:3600 MINNESOTA DR
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-7979
Practice Address - Country:US
Practice Address - Phone:952-595-1100
Practice Address - Fax:612-294-4903
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41782085P0229X, 2085R0202X
TXM17702085P0229X, 2085R0202X
MO20050327302085P0229X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200108801Medicaid
MOP00324878OtherRRR MEDICARE
MO1256OtherBLUE
AR160675003Medicaid
MO200108801Medicaid
MO956770242Medicare PIN