Provider Demographics
NPI:1487619383
Name:HONAKER, PATRICK ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:ALLEN
Last Name:HONAKER
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 1:412 KIMBALL DR
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:SC
Mailing Address - Zip Code:29571-1916
Mailing Address - Country:US
Mailing Address - Phone:843-423-9057
Mailing Address - Fax:
Practice Address - Street 1:600 E PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2851
Practice Address - Country:US
Practice Address - Phone:843-667-9414
Practice Address - Fax:843-667-1362
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17870207L00000X, 207LP2900X
NC9500942207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8906437Medicaid
SC183027OtherMEDCOST
SC178701Medicaid
SC570835798OtherSTANDARD TAX ID
SC155031900OtherUS DEPT OF LABOR
SCP00247022Medicare ID - Type UnspecifiedRAILROAD MEDICARE
SCF496002921Medicare PIN
SC178701Medicaid
SC570835798OtherSTANDARD TAX ID
SCF496005798Medicare Oscar/Certification