Provider Demographics
NPI:1346239829
Name:HANCOCK, JAMES CHARLES (PAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:CHARLES
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3569 NE 163RD ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4132
Mailing Address - Country:US
Mailing Address - Phone:305-945-2411
Mailing Address - Fax:305-945-2412
Practice Address - Street 1:3569 NE 163RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33160-4132
Practice Address - Country:US
Practice Address - Phone:305-945-2411
Practice Address - Fax:305-945-2412
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101295363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4332ZMedicare ID - Type Unspecified
P09857Medicare UPIN