Provider Demographics
NPI:1003870726
Name:HISCOK, PERRY S (MD)
Entity Type:Individual
Prefix:DR
First Name:PERRY
Middle Name:S
Last Name:HISCOK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 27340
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85061-7340
Mailing Address - Country:US
Mailing Address - Phone:602-943-9200
Mailing Address - Fax:602-216-3000
Practice Address - Street 1:7111 W BELL RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8551
Practice Address - Country:US
Practice Address - Phone:623-533-4465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ274712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ468943Medicaid
AZAZ0782750OtherBCBSAZ
AZP00308OtherHEALTH NET OF ARIZONA
AZAZ0782750OtherBCBSAZ
AZP00308017Medicare PIN
AZ468943Medicaid