Healthcare Provider Details

I. General information

NPI: 1477633386
Provider Name (Legal Business Name): LISA JENNIFER HAZARD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 03/18/2022
Certification Date: 03/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6567 E CARONDELET DR STE 185
TUCSON AZ
85710-6161
US

IV. Provider business mailing address

1760 E RIVER RD STE 350
TUCSON AZ
85718-5999
US

V. Phone/Fax

Practice location:
  • Phone: 520-546-1778
  • Fax: 520-546-3125
Mailing address:
  • Phone: 520-519-7700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD61259566
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0205X
TaxonomyRadiological Physics Physician
License Number48730081205
License Number StateUT
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number42470
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: