Healthcare Provider Details

I. General information

NPI: 1952831083
Provider Name (Legal Business Name): KYLE HAZELWOOD MD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 SE BISHOP BLVD STE 120
PULLMAN WA
99163-5517
US

IV. Provider business mailing address

825 SE BISHOP BLVD STE 120
PULLMAN WA
99163-5517
US

V. Phone/Fax

Practice location:
  • Phone: 509-332-2828
  • Fax:
Mailing address:
  • Phone: 509-332-2828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. KYLE HAZELWOOD
Title or Position: PHYSICIAN
Credential: MD
Phone: 509-332-2828