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General NPI Number Information
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NPI Number | 1235584533
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Entity Type | Individual
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Provider Name | JOEL HANCOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 05/20/2022
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Provider Practice Location Address
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Address Line | 2114 VILLAGE PARK AVE
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City | TWIN FALLS
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State | ID
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Zip | 83301-4172
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Country | US
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Telephone | 208-733-3404
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Fax | 866-939-1381
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Provider Business Mailing Address
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Address Line | 3278 MEADOW RIDGE LN
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City | TWIN FALLS
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State | ID
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Zip | 83301-8178
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Country | US
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Telephone | 801-648-5852
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 1235584533
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | M-15799
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License Number State | ID
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