MEDICARE: DR. JOHN R. HAZELTON M.D.

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
1	207W00000X	Ophthalmology Physician	22986	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00160285	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1659394146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN R. HAZELTON M.D.

Provider Business Mailing Address
First Line	:	4055 HWY. 17 SOUTH
Second Line	:	P.O. BOX 1919
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576
Country	:	US
Telephone Number	:	843-652-3939
Fax Number	:	843-652-3939

Provider Business Practice Location Address
First Line	:	4055 HWY. 17 SOUTH
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576
Country	:	US
Telephone Number	:	843-652-3939
Fax Number	:	843-652-3939

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2006
Last Update Date	:	05/02/2008

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