MEDICARE: DR. PERRY S HISCOK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	27471	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	AZ0782750	OTHER	AZ	BCBSAZ
3	P00308	OTHER	AZ	HEALTH NET OF ARIZONA

General Provider Information

NPI Number	:	1003870726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PERRY S HISCOK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 27340
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85061-7340
Country	:	US
Telephone Number	:	602-943-9200
Fax Number	:	602-216-3000

Provider Business Practice Location Address
First Line	:	7111 W BELL RD
Second Line	:	SUITE 104
City	:	GLENDALE
State	:	AZ
Zip	:	85308-8551
Country	:	US
Telephone Number	:	623-533-4465
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2006
Last Update Date	:	12/05/2007

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