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Individual
MR. THOMAS VAN HORN
Active
Individual
MR. THOMAS VAN HORN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00103
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117359303
—
TX
01
—
742843212
TAX ID
TX
01
—
86N029
BLUE CROSS BLUE SHIELD
TX
01
—
970004841
RAILROAD MEDICARE
TX
Enumeration date
08/02/2005
Last updated
06/25/2012
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