Provider Demographics
NPI:1295730331
Name:HORNER, GREGORY (MD)
Entity type:Individual
Prefix:
First Name:GREGORY
Middle Name:
Last Name:HORNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4626 WILLOW RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-8517
Mailing Address - Country:US
Mailing Address - Phone:925-463-0470
Mailing Address - Fax:925-463-0473
Practice Address - Street 1:4626 WILLOW RD
Practice Address - Street 2:SUITE 200
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-8517
Practice Address - Country:US
Practice Address - Phone:925-463-0470
Practice Address - Fax:925-463-0473
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2014-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54276207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA200039899OtherMEDICARE RAILROAD
CA00A542763Medicare PIN
CA200039899OtherMEDICARE RAILROAD
CAH05725Medicare UPIN
CA00A542765Medicare PIN