Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 36645 | CO |
NPI | 1003954637 |
---|---|
Provider Name | Mark Robert Hancock |
First Address | Aurora, CO 80042-0429 |
Second Address | Hays, KS 67601-2370 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2007 |
Last Update Date | 08/11/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01366459 | (05) | CO |
1003954637 | (05) | UT |
E04417 | (02) |