Provider Demographics
NPI:1902874662
Name:HANCOCK, JERRY M (DO)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:M
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:1314 EAST WALNUT STREET
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501
Mailing Address - Country:US
Mailing Address - Phone:812-254-2760
Mailing Address - Fax:812-257-8602
Practice Address - Street 1:1402 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501
Practice Address - Country:US
Practice Address - Phone:812-254-6696
Practice Address - Fax:812-254-7934
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2024-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000363A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000094084OtherANTHEM
INCG3197OtherMEDICARE RAILROAD GROUP
IN000000094084OtherANTHEM
IN941190AAAMedicare ID - Type Unspecified