Basic Information
| Provider Information | |||||||||
| NPI: | 1699717033 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JEFFREY E. HAZLEWOOD, M.D., P.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2149 | ||||||||
| Address2: | |||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370882149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154443307 | ||||||||
| FaxNumber: | 6154445579 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 PHYSICIANS WAY | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LEBANON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370908102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154443307 | ||||||||
| FaxNumber: | 6154445579 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 03/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | HAZLEWOOD | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | E. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6154443307 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208100000X | MD0000027823 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 4121917 | 01 | TN | BCBS | OTHER | 3733565 | 05 | TN | MEDICAID |