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NPI Code Detail

MEDICARE: MR. RICHARD D. HAZEN P.A.

MEDICARE: MR. RICHARD D. HAZEN P.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant00356CO

General Provider Information

NPI Number : 1538181961
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD D. HAZEN P.A.
Provider Business Mailing Address
First Line : 1150 EAGLE RD
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-1222
Country : US
Telephone Number : 303-465-4314
Fax Number :
Provider Business Practice Location Address
First Line : 1420 W MIDWAY BLVD
Second Line :
City : BROOMFIELD
State : CO
Zip : 80020-2090
Country : US
Telephone Number : 303-466-1866
Fax Number : 303-466-4081
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/24/2006
Last Update Date : 07/08/2007

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