Provider Demographics
NPI:1487282422
Name:HORTON, JACOB BRYAN (MD, MBA)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:BRYAN
Last Name:HORTON
Suffix:
Gender:M
Credentials:MD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:29 AUDUBON ST APT 603
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6526
Mailing Address - Country:US
Mailing Address - Phone:203-244-7740
Mailing Address - Fax:207-610-7889
Practice Address - Street 1:1 LONG WHARF DR
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-5991
Practice Address - Country:US
Practice Address - Phone:203-781-4357
Practice Address - Fax:203-781-4658
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2025-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
CT773572084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program