Provider Demographics
NPI:1316300437
Name:HUNEYCUTT, MATTHEW ALLEN (CSFA)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALLEN
Last Name:HUNEYCUTT
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14522 BUCKING TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4413
Mailing Address - Country:US
Mailing Address - Phone:210-823-8928
Mailing Address - Fax:
Practice Address - Street 1:14522 BUCKING TRL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4413
Practice Address - Country:US
Practice Address - Phone:210-823-8928
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165148246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant