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General NPI Number Information
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NPI Number | 1497967376
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Entity Type | Individual
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Provider Name | DR. TAL BEN HAZAN
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 4420 LAKE BOONE TRL
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City | RALEIGH
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State | NC
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Zip | 27607-7505
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Country | US
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Telephone | 919-791-2040
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Fax | 919-791-2041
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Provider Business Mailing Address
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Address Line | 4790 BARKLEY CIR BLDG A BARKLEY SURGERY CENTER, INC.
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City | FORT MYERS
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State | FL
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Zip | 33907-7543
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Country | US
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Telephone | 239-275-8882
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Fax | 239-275-6304
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | ME107950
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 2024-02680
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License Number State | NC
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