Provider Demographics
NPI:1861959421
Name:CAINE, HORATIO L
Entity type:Individual
Prefix:
First Name:HORATIO
Middle Name:L
Last Name:CAINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6106 CASTLETON CV
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-9444
Mailing Address - Country:US
Mailing Address - Phone:662-893-0204
Mailing Address - Fax:
Practice Address - Street 1:6106 CASTLETON CV
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-9444
Practice Address - Country:US
Practice Address - Phone:662-893-0204
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-01
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator