Healthcare Provider Details

I. General information

NPI: 1417914961
Provider Name (Legal Business Name): DARCI RENEE HAZELWOOD DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DARCI R. HAZELWOOD D.O.

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 04/19/2025
Certification Date: 04/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7333 N 199TH EAST AVE
OWASSO OK
74055-5869
US

IV. Provider business mailing address

7333 N 199TH EAST AVE
OWASSO OK
74055-5869
US

V. Phone/Fax

Practice location:
  • Phone: 918-720-3711
  • Fax:
Mailing address:
  • Phone: 918-720-3711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4193
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number4193
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: