Provider Demographics
NPI:1568469443
Name:HONEYCUTT, LORI F (MD)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:F
Last Name:HONEYCUTT
Suffix:
Gender:F
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 2166
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78297-2166
Mailing Address - Country:US
Mailing Address - Phone:512-257-7600
Mailing Address - Fax:512-257-7604
Practice Address - Street 1:1103 CYPRESS CREEK RD
Practice Address - Street 2:STE 100
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-3925
Practice Address - Country:US
Practice Address - Phone:512-257-7600
Practice Address - Fax:512-257-7604
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6429207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0009KZOtherBCBS
TX00562WMedicare PIN
TX0009KZOtherBCBS