Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 3069 | OK |
Y | 207Q00000X | Family Doctor | 3069 | OK |
NPI | 1275518045 |
---|---|
Provider Name | Dr. Constance Gilbert Honeycutt |
First Address | Glenpool, OK 74033-2618 |
Second Address | Glenpool, OK 74033-2618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/12/2005 |
Last Update Date | 26/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100048360D | (05) | OK |
F36345 | (02) | OK |