Healthcare Provider Details

I. General information

NPI: 1194713222
Provider Name (Legal Business Name): JOSEPH E HANCOCK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3502 9TH ST SUITE 360
LUBBOCK TX
79415-3300
US

IV. Provider business mailing address

PO BOX 64864
LUBBOCK TX
79490
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0747
  • Fax: 806-761-0751
Mailing address:
  • Phone: 806-785-2045
  • Fax: 806-785-0872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberH8676
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: