Provider Demographics
NPI:1467495325
Name:HANCOCK, KENNETH CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:CHARLES
Last Name:HANCOCK
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:500 S HENDERSON ST STE 200
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2154
Practice Address - Country:US
Practice Address - Phone:174-131-5008
Practice Address - Fax:817-413-1499
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3068207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137579201Medicaid
TX137579206Medicaid
TX137579209Medicaid
TX137579212Medicaid
TX137579204Medicaid
TX137579205Medicaid
TX137579211Medicaid
TX137579202Medicaid
TX137579203Medicaid
TX8R1454OtherBLUE CROSS OF TEXAS
TX137579208Medicaid
TX137579210Medicaid
TX87714KMedicare PIN
TXE82895Medicare UPIN
TX8R1454OtherBLUE CROSS OF TEXAS
TX137579201Medicaid
TX137579206Medicaid