Healthcare Provider Details

I. General information

NPI: 1689637209
Provider Name (Legal Business Name): SANDRA JO HAZELIP DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 12/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 SOUTH 27TH
ABILENE TX
79605
US

IV. Provider business mailing address

3101 SOUTH 27TH
ABILENE TX
79605
US

V. Phone/Fax

Practice location:
  • Phone: 325-695-1289
  • Fax: 325-695-1296
Mailing address:
  • Phone: 325-695-1289
  • Fax: 325-695-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberG8171
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207QH0002X
TaxonomyHospice and Palliative Medicine (Family Medicine) Physician
License NumberG8171
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG8171
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: