MEDICARE: JOEL HANCOCK M.D.

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	208800000X	Urology Physician	1235584533	TN
2	390200000X	Student in an Organized Health Care Education/Training Program
3	208800000X	Urology Physician	M-15799	ID

General Provider Information

NPI Number	:	1235584533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL HANCOCK M.D.

Provider Business Mailing Address
First Line	:	3278 MEADOW RIDGE LN
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-8178
Country	:	US
Telephone Number	:	801-648-5852
Fax Number	:

Provider Business Practice Location Address
First Line	:	2114 VILLAGE PARK AVE
Second Line	:
City	:	TWIN FALLS
State	:	ID
Zip	:	83301-4172
Country	:	US
Telephone Number	:	208-733-3404
Fax Number	:	866-939-1381

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

Provider Enumeration Date	:	04/25/2016
Last Update Date	:	05/20/2022

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