Provider Demographics
NPI:1093030033
Name:HATHCOCK, ALAN JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:JOSEPH
Last Name:HATHCOCK
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 1:2637 MIDPOINT DR STE B
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4408
Mailing Address - Country:US
Mailing Address - Phone:970-488-1666
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:2637 MIDPOINT DR STE B
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4408
Practice Address - Country:US
Practice Address - Phone:970-488-1666
Practice Address - Fax:970-472-9381
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0056304207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2146777Medicaid
MS08187553Medicaid
MS08187553Medicaid