Provider Demographics
NPI:1619013281
Name:WALTER C HANCOCK DPM
Entity Type:Organization
Organization Name:WALTER C HANCOCK DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DPM
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:812-482-4488
Mailing Address - Street 1:603 DORBETT ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2615
Mailing Address - Country:US
Mailing Address - Phone:812-482-4488
Mailing Address - Fax:812-482-5588
Practice Address - Street 1:603 DORBETT ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-2615
Practice Address - Country:US
Practice Address - Phone:812-482-4488
Practice Address - Fax:812-482-5588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WALTER C HANCOCK DPM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000108408OtherANTHEM BLUE SHIELD
IN211910Medicare ID - Type Unspecified
000000108408OtherANTHEM BLUE SHIELD