MEDICARE: MS. KERRIAN A HAZLEY MD

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	207Q00000X	Family Medicine Physician	051502	CT
2	207Q00000X	Family Medicine Physician	ME117182	FL

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

General Provider Information

NPI Number	:	1689802993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KERRIAN A HAZLEY MD

Provider Business Mailing Address
First Line	:	362 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8457

Provider Business Practice Location Address
First Line	:	362 STATE HIGHWAY 83
Second Line	:
City	:	DEFUNIAK SPRINGS
State	:	FL
Zip	:	32433-3800
Country	:	US
Telephone Number	:	850-892-8015
Fax Number	:	850-892-8457

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

Provider Enumeration Date	:	06/25/2009
Last Update Date	:	04/13/2022

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