Provider Demographics
NPI:1427545722
Name:HORNOK, JEFFREY JOHN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:JOHN
Last Name:HORNOK
Suffix:
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 1:24481 INTERSTATE 20
Mailing Address - Street 2:
Mailing Address - City:WILLS POINT
Mailing Address - State:TX
Mailing Address - Zip Code:75169-9303
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24481 INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:WILLS POINT
Practice Address - State:TX
Practice Address - Zip Code:75169-9303
Practice Address - Country:US
Practice Address - Phone:903-292-3013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver