Healthcare Provider Details

I. General information

NPI: 1467495325
Provider Name (Legal Business Name): KENNETH CHARLES HANCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S HENDERSON ST STE 200
FORT WORTH TX
76104-2154
US

IV. Provider business mailing address

PO BOX 911230
DALLAS TX
75391-1230
US

V. Phone/Fax

Practice location:
  • Phone: 174-131-5008
  • Fax: 817-413-1499
Mailing address:
  • Phone: 972-997-8000
  • Fax: 972-437-9605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberH3068
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: