Healthcare Provider Details

I. General information

NPI: 1083885016
Provider Name (Legal Business Name): BRIAN HANCOCK MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/18/2008
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

841 NE 7TH ST
GRANTS PASS OR
97526-1634
US

IV. Provider business mailing address

841 NE 7TH ST
GRANTS PASS OR
97526-1634
US

V. Phone/Fax

Practice location:
  • Phone: 541-474-2721
  • Fax: 541-474-0056
Mailing address:
  • Phone: 541-474-2721
  • Fax: 541-474-0056

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN EUGENE HANCOCK
Title or Position: PHYSICIAN/OWNER
Credential: M.D.
Phone: 541-474-2721