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General NPI Number Information
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NPI Number | 1700988623
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Entity Type | Individual
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Provider Name | SAMUEL HAZELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/01/2006
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Last Update Date | 02/24/2011
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Provider Practice Location Address
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Address Line | 1859 SAVAGE RD
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City | CHARLESTON
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State | SC
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Zip | 29407-4726
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Country | US
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Telephone | 843-723-2835
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Fax | 843-722-8948
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Provider Business Mailing Address
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Address Line | PO BOX 751649
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City | CHARLOTTE
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State | NC
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Zip | 28275-1649
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Country | US
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Telephone | 843-789-1620
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Fax | 843-724-2454
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 10048
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License Number State | SC
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