Provider Demographics
NPI:1437345964
Name:GEORGE R. HANCOCK M.D., INC
Entity Type:Organization
Organization Name:GEORGE R. HANCOCK M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-352-6766
Mailing Address - Street 1:17853 SANTIAGO BLVD
Mailing Address - Street 2:#107 PMB 104
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-4113
Mailing Address - Country:US
Mailing Address - Phone:760-352-6766
Mailing Address - Fax:760-353-8105
Practice Address - Street 1:790 W ORANGE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-3274
Practice Address - Country:US
Practice Address - Phone:760-352-6766
Practice Address - Fax:760-353-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-18
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32642207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A326421Medicaid
CA00A326421Medicaid
CAA26876Medicare UPIN