Basic Information
| Provider Information | |||||||||
| NPI: | 1801880687 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HORAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 460 BURMA RD W | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | NC | ||||||||
| PostalCode: | 287525278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8283183284 | ||||||||
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| Practice Location | |||||||||
| Address1: | 220 NASH MEDICAL ARTS MALL | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278041470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2529624550 | ||||||||
| FaxNumber: | 2529624551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2005 | ||||||||
| LastUpdateDate: | 06/03/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 9400274 | NC | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 8944466 | 05 | NC | MEDICAID |