MEDICARE: MR. JAMES CHARLES HANCOCK PAC

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	363A00000X	Physician Assistant	PA9101295	FL

General Provider Information

NPI Number	:	1346239829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES CHARLES HANCOCK PAC

Provider Business Mailing Address
First Line	:	3569 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4132
Country	:	US
Telephone Number	:	305-945-2411
Fax Number	:	305-945-2412

Provider Business Practice Location Address
First Line	:	3569 NE 163RD ST
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33160-4132
Country	:	US
Telephone Number	:	305-945-2411
Fax Number	:	305-945-2412

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	07/08/2007

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