Basic Information
| Provider Information | |||||||||
| NPI: | 1538106778 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORNBACK | ||||||||
| FirstName: | CLIFFORD | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1702 LAFAYETTE ROAD | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653624400 | ||||||||
| FaxNumber: | 7653641797 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 LAFAYETTE ROAD | ||||||||
| Address2: | |||||||||
| City: | CRAWFORDSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 47933 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7653624400 | ||||||||
| FaxNumber: | 7653641797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/31/2006 | ||||||||
| LastUpdateDate: | 01/15/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 01036782A | IN | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.