Provider Demographics
NPI:1982693693
Name:HANCOCK, CRAIG EDWARD (MD)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:EDWARD
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:C.
Other - Middle Name:EDWARD
Other - Last Name:HANCOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1201 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 14000
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210-2008
Mailing Address - Country:US
Mailing Address - Phone:480-545-8119
Mailing Address - Fax:480-892-6805
Practice Address - Street 1:6424 E BROADWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1750
Practice Address - Country:US
Practice Address - Phone:480-456-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2019-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ193192085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ001347Medicaid
AZZ165405Medicare PIN
AZ001347Medicaid
30WCFCQ20Medicare ID - Type UnspecifiedARL
AZ001347Medicaid