MEDICARE: SAMUEL BRANDON HANCOCK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	26546	OK

General Provider Information

NPI Number	:	1063672608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMUEL BRANDON HANCOCK MD

Provider Business Mailing Address
First Line	:	1705 RENAISSANCE BLVD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3041
Country	:	US
Telephone Number	:	405-285-7500
Fax Number	:	405-285-7501

Provider Business Practice Location Address
First Line	:	4510 NW 39TH ST
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73122-2503
Country	:	US
Telephone Number	:	405-495-5841
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2008
Last Update Date	:	08/12/2016

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