Healthcare Provider Details

I. General information

NPI: 1003241449
Provider Name (Legal Business Name): SCOTT L. HAZELWOOD, DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 09/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 EASTERN BYP
RICHMOND KY
40475-2751
US

IV. Provider business mailing address

PO BOX 34166
LEXINGTON KY
40588-4166
US

V. Phone/Fax

Practice location:
  • Phone: 859-623-3131
  • Fax: 260-407-8009
Mailing address:
  • Phone: 859-623-3131
  • Fax: 260-407-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number03083
License Number StateKY

VIII. Authorized Official

Name: DR. SCOTT L HAZELWOOD
Title or Position: OWNER
Credential: DO
Phone: 859-623-3131