Individual
EARL RODNEY HORNBAKE III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10 WILDWOOD MEDICAL CTR, ESSEX, CT 06426-1154
(860) 767-0145
(860) 767-0021
Mailing address
10 WILDWOOD MEDICAL CTR, ESSEX, CT 06426-1154
(860) 767-0145
(860) 767-0021
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
034326
CT
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
034326
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001343269
—
CT
01
—
034326
LICENSE
CT
01
—
C03139
MEDICARE GROUP NUMBER
—
Enumeration date
08/10/2005
Last updated
07/24/2012
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