Provider Demographics
NPI:1316048192
Name:HORNBARGER, CRAIG (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:HORNBARGER
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 1:10107 RIDGEGATE PKWY STE 370
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6003
Mailing Address - Country:US
Mailing Address - Phone:720-282-8006
Mailing Address - Fax:
Practice Address - Street 1:10107 RIDGEGATE PKWY STE 370
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6003
Practice Address - Country:US
Practice Address - Phone:720-282-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41754208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41754OtherSTATE LICENSE NUMBER
CO48587061Medicaid
CO510468960OtherTIN
CO41754OtherSTATE LICENSE NUMBER