Provider Demographics
NPI:1649374109
Name:HORTON, CLAIRE KATHERINE (MD)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:KATHERINE
Last Name:HORTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:3451 E 12TH STREET
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-535-3500
Practice Address - Fax:510-535-4187
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71387207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71021FMedicaid
CAHAP71021FOtherFPACT
CAZZZ29799ZOtherFQHC MEDICARE PART B
CA55-1975OtherFQHC MEDICARE PART A
H29150Medicare UPIN