Provider Demographics
NPI:1427154822
Name:ROBERT R. HORANZY M.D. LLC
Entity type:Organization
Organization Name:ROBERT R. HORANZY M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HORANZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:580-369-2803
Mailing Address - Street 1:RR 2 BOX 396
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:OK
Mailing Address - Zip Code:73086-9674
Mailing Address - Country:US
Mailing Address - Phone:580-369-2803
Mailing Address - Fax:580-369-3497
Practice Address - Street 1:107 S 3RD ST
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:OK
Practice Address - Zip Code:73030-2305
Practice Address - Country:US
Practice Address - Phone:580-369-2803
Practice Address - Fax:580-369-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK168463590-001OtherBLUECROSS
OK168463590-001OtherBLUECROSS
OK168463590-001OtherBLUECROSS