Provider Demographics
NPI:1982709143
Name:HORTON, JOHN GARY (DO)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:GARY
Last Name:HORTON
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 1:9580 WOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:45710-9205
Mailing Address - Country:US
Mailing Address - Phone:740-593-6262
Mailing Address - Fax:740-594-6262
Practice Address - Street 1:380 COLONIAL DR
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9215
Practice Address - Country:US
Practice Address - Phone:740-446-5001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH002259207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2092122Medicaid
OH2092122Medicaid
C25482Medicare UPIN