Provider Demographics
NPI:1235415175
Name:HANCOCK, JUSTIN DWAIN (PA-C)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:DWAIN
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 STATE HIGHWAY 6 S STE 500
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-5820
Mailing Address - Country:US
Mailing Address - Phone:254-366-4247
Mailing Address - Fax:
Practice Address - Street 1:3995 STATE HIGHWAY 6 S STE 500
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-5820
Practice Address - Country:US
Practice Address - Phone:979-485-9449
Practice Address - Fax:979-485-9448
Is Sole Proprietor?:No
Enumeration Date:2011-10-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07477363A00000X
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant