Healthcare Provider Details

I. General information

NPI: 1922462019
Provider Name (Legal Business Name): WILLIAM CALEB HANCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 06/24/2021
Certification Date: 06/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CHILDRENS AVE STE 12506
OKLAHOMA CITY OK
73104-4637
US

IV. Provider business mailing address

1200 CHILDRENS AVE STE 12506
OKLAHOMA CITY OK
73104-4637
US

V. Phone/Fax

Practice location:
  • Phone: 405-271-1456
  • Fax: 405-271-2281
Mailing address:
  • Phone: 405-271-1456
  • Fax: 405-271-6214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number38062
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: