Provider Demographics
NPI:1174622732
Name:HONEYCUTT, JOHNNIE H (MD)
Entity type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:H
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 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:682-885-2500
Practice Address - Fax:682-885-2510
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1151207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U87ZOtherBCBSTX GRP PIN
TX7381325OtherAETNA PIN
TX2010516OtherCCN PIN
TX145366100OtherFIRSTCARE PIN
TX137345810Medicaid
TX2010516OtherFIRSTHEALTH PIN
TX173126702Medicaid
1750369203OtherGRP NPI NUMBER
TX8G3392OtherBCBSTX IND PIN
TX10018630OtherAMERIGROUP PIN
TX140442852Medicaid
TX173126701Medicaid
TX2203790OtherUHC PIN
TX9092394OtherCIGNA PIN
TX2010516OtherFIRSTHEALTH PIN
TX173126701Medicaid
TX140442852Medicaid