Provider Demographics
NPI:1588689392
Name:HAZEL, JAMES R (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:HAZEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6703 W RIO GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-2623
Mailing Address - Country:US
Mailing Address - Phone:509-946-6144
Mailing Address - Fax:509-783-5438
Practice Address - Street 1:821 SWIFT BLVD
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-7623
Practice Address - Country:US
Practice Address - Phone:509-460-5588
Practice Address - Fax:509-783-5438
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2016-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00026478207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1065820Medicaid
WA200036795OtherRR MEDICARE
WA116833OtherLABOR & INDUSTRIES
WA200036795OtherRR MEDICARE
WAGAB01869Medicare PIN
1259080001Medicare NSC