Basic Information
| Provider Information | |||||||||
| NPI: | 1114916251 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HONEYCUTT | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 995 | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 405880995 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4237478426 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1101 VETERANS DRIVE | ||||||||
| Address2: | |||||||||
| City: | LEXINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 40502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8592334511 | ||||||||
| FaxNumber: | 8592814806 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/20/2005 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083C0008X | 41428 | TN | N | 2085R0202X | MD41428 | TN | N | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | 41428 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology |
ID Information
| ID | Type | State | Issuer | Description | 151125 | 05 | TN | MEDICAID |