Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 22DI00934900 | NJ |
NPI | 1093737157 |
---|---|
Provider Name | Dr. Raymond R. Hancock |
First Address | Marlton, NJ 08053-2098 |
Second Address | Marlton, NJ 08053-2098 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |