Provider Demographics
NPI:1649383852
Name:HANCOCK, WALTER (DPM)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
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 1:2042 LINCOLN AVENUE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714
Mailing Address - Country:US
Mailing Address - Phone:812-477-1821
Mailing Address - Fax:812-475-0327
Practice Address - Street 1:2042 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-1561
Practice Address - Country:US
Practice Address - Phone:812-477-1821
Practice Address - Fax:812-475-0327
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07000330213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100110420Medicaid
IN100110420Medicaid
INT81871Medicare UPIN
IN0243760002Medicare NSC