Provider Demographics
NPI:1538157102
Name:HORANZY, ROBERT RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAYMOND
Last Name:HORANZY
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: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:580-622-2279
Mailing Address - Fax:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20039207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKG25962Medicare UPIN