Provider Demographics
NPI:1679150890
Name:HORN, AUSTIN FORSYTHE I
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:FORSYTHE
Last Name:HORN
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MEDICAL CITY ARLINGTON
Mailing Address - Street 2:3301 MATLOCK ROAD,
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76015-9798
Mailing Address - Country:US
Mailing Address - Phone:503-480-5388
Mailing Address - Fax:
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SUBLIMITY
Practice Address - State:OR
Practice Address - Zip Code:97385-9798
Practice Address - Country:US
Practice Address - Phone:503-480-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-24
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program