Provider Demographics
NPI:1972531127
Name:HORTON, THOMAS LEON (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:LEON
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 1:421 MEDICAL CENTER DR SW
Mailing Address - Street 2:
Mailing Address - City:FORT PAYNE
Mailing Address - State:AL
Mailing Address - Zip Code:35968-3421
Mailing Address - Country:US
Mailing Address - Phone:256-845-1401
Mailing Address - Fax:256-845-1402
Practice Address - Street 1:421 MEDICAL CENTER DR SW
Practice Address - Street 2:
Practice Address - City:FORT PAYNE
Practice Address - State:AL
Practice Address - Zip Code:35968-3421
Practice Address - Country:US
Practice Address - Phone:256-845-1401
Practice Address - Fax:256-845-1402
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2016-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS09300207Q00000X
AL13953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL080012355OtherRAILROAD MEDICARE PTAN
AL511-07803OtherBLUE CROSS BLUE SHIELD OF ALABAMA
MS02952029Medicaid
AL144086Medicaid
MSP00620206OtherRAILROAD MEDICARE PTAN
MS512I080011Medicare PIN
AL511-07803OtherBLUE CROSS BLUE SHIELD OF ALABAMA
MS02952029Medicaid
MS02952029Medicaid
AL000018185Medicare PIN