Healthcare Provider Details

I. General information

NPI: 1093869612
Provider Name (Legal Business Name): WALTER HANCOCK DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 06/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2042 LINCOLN AVE
EVANSVILLE IN
47714-1561
US

IV. Provider business mailing address

2042 LINCOLN AVE
EVANSVILLE IN
47714-1561
US

V. Phone/Fax

Practice location:
  • Phone: 812-477-1821
  • Fax: 812-475-0327
Mailing address:
  • Phone: 812-477-1821
  • Fax: 812-475-0327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000330
License Number StateIN

VIII. Authorized Official

Name: MR. WALTER HANCOCK
Title or Position: DPM
Credential: DPM
Phone: 812-477-1821