Basic Information
| Provider Information | |||||||||
| NPI: | 1477633386 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAZARD | ||||||||
| FirstName: | LISA | ||||||||
| MiddleName: | JENNIFER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1760 E RIVER RD STE 350 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857185999 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205197700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6567 E CARONDELET DR STE 185 | ||||||||
| Address2: | |||||||||
| City: | TUCSON | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 857106161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5205461778 | ||||||||
| FaxNumber: | 5205463125 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2006 | ||||||||
| LastUpdateDate: | 03/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | MD61259566 | WA | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0205X | 48730081205 | UT | N | Allopathic & Osteopathic Physicians | Radiology | Radiological Physics | 2085R0001X | 42470 | AZ | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 465199 | 05 | AZ | MEDICAID |