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Individual

DR. JONATHAN BRENT HANCOCK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
2300 E 30TH ST STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202
Mailing address
2300 E 30TH ST STE 101, FARMINGTON, NM 87401-8990
(505) 327-1400
(505) 564-3202

Taxonomy

Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
A-1965-16
NM
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
A-1965-16
NM
207XX0801X
Orthopaedic Trauma Physician
A-1965-16
NM

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
27221822
NM
Enumeration date
05/17/2011
Last updated
07/21/2022
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