Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 22202 | WI |
N | 111NI0900X | Internist | 22202 | WI |
Y | 207RG0300X | Geriatric Medicine | 22202 | WI |
NPI | 1083763379 |
---|---|
Provider Name | Curtis Wayne Hancock |
First Address | Sheboygan, WI 53083-5003 |
Second Address | Sheboygan, WI 53081-3129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2007 |
Last Update Date | 01/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30274300 | (05) | WI |
B53366 | (02) |