Provider Demographics
NPI:1679512818
Name:HANCOCK, JERRY ARTHUR (MD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:ARTHUR
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 1:330 LAUREL ST
Mailing Address - Street 2:#1100
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314-3034
Mailing Address - Country:US
Mailing Address - Phone:515-288-3287
Mailing Address - Fax:515-288-3200
Practice Address - Street 1:330 LAUREL ST
Practice Address - Street 2:#1100
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314-3034
Practice Address - Country:US
Practice Address - Phone:515-288-3287
Practice Address - Fax:515-288-3200
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28152207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0075846Medicaid
IAE46520Medicare UPIN
IA04338Medicare ID - Type Unspecified