Healthcare Provider Details

I. General information

NPI: 1346279221
Provider Name (Legal Business Name): JOSEPH E. HANCOCK MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 64864
LUBBOCK TX
79464-4864
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: JOSEPH HANCOCK
Title or Position: MD
Credential: MD
Phone: 806-761-0747