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NPI Code Detail

MEDICARE: DR. RANDY CHARLES HANCOCK DO

MEDICARE: DR. RANDY CHARLES HANCOCK DO
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
1207Q00000XFamily Medicine Physician3297AZ

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2Z131033OTHERMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1467432971
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RANDY CHARLES HANCOCK DO
Provider Business Mailing Address
First Line : PO BOX 1958
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-1958
Country : US
Telephone Number : 623-374-0200
Fax Number : 623-374-5576
Provider Business Practice Location Address
First Line : 19251 E OASIS DR
Second Line :
City : BLACK CANYON CITY
State : AZ
Zip : 85324-8878
Country : US
Telephone Number : 623-374-0200
Fax Number : 623-374-5576
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2006
Last Update Date : 12/16/2022

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