Provider Demographics
NPI:1396757878
Name:HANCOCK, DAVID J (DPM)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:J
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:DPM
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 490552
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34749-0552
Mailing Address - Country:US
Mailing Address - Phone:352-255-3302
Mailing Address - Fax:
Practice Address - Street 1:900 HIGHWAY 466
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-3926
Practice Address - Country:US
Practice Address - Phone:352-255-3302
Practice Address - Fax:352-435-7904
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3579213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8AD032OtherBLUE CROSS/BLUE SHIELD
6164130002Medicare NSC
00X950Medicare PIN