Healthcare Provider Details

I. General information

NPI: 1497967376
Provider Name (Legal Business Name): DR. TAL BEN HAZAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 03/05/2025
Certification Date: 03/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

4790 BARKLEY CIR BLDG A BARKLEY SURGERY CENTER, INC.
FORT MYERS FL
33907-7543
US

V. Phone/Fax

Practice location:
  • Phone: 919-791-2040
  • Fax: 919-791-2041
Mailing address:
  • Phone: 239-275-8882
  • Fax: 239-275-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME107950
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number2024-02680
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: