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General NPI Number Information
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NPI Number | 1093869612
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Entity Type | Organization
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Legal Business Name | WALTER HANCOCK DPM PC
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 2042 LINCOLN AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-1561
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Country | US
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Telephone | 812-477-1821
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Fax | 812-475-0327
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Provider Business Mailing Address
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Address Line | 2042 LINCOLN AVE
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City | EVANSVILLE
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State | IN
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Zip | 47714-1561
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Country | US
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Telephone | 812-477-1821
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Fax | 812-475-0327
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Authorized Official
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Title or Position | DPM
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Name | MR. WALTER HANCOCK
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Credential | DPM
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Telephone | 812-477-1821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 07000330
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License Number State | IN
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