Provider Demographics
NPI:1114916251
Name:HONEYCUTT, JEFFREY W (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:W
Last Name:HONEYCUTT
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:PO BOX 995
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-0995
Mailing Address - Country:US
Mailing Address - Phone:423-747-8426
Mailing Address - Fax:
Practice Address - Street 1:1101 VETERANS DRIVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40502
Practice Address - Country:US
Practice Address - Phone:859-233-4511
Practice Address - Fax:859-281-4806
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN414282083C0008X, 2085R0204X
TNMD414282085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2083C0008XAllopathic & Osteopathic PhysiciansPreventive MedicineClinical Informatics
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN151125Medicaid
3820778Medicare PIN
TN151125Medicaid