Provider Demographics
NPI:1962410126
Name:HORTON, RAYMOND CHRISTOPHER GUY (MD)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHRISTOPHER GUY
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 1:12423 KEMERTON LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-3710
Mailing Address - Country:US
Mailing Address - Phone:704-992-5591
Mailing Address - Fax:
Practice Address - Street 1:12423 KEMERTON LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-3710
Practice Address - Country:US
Practice Address - Phone:704-992-5591
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200400515207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89137KKMedicaid
SCT66700Medicaid
NC89137KKMedicaid
NCH40390Medicare UPIN