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General NPI Number Information
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NPI Number | 1952831083
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Entity Type | Organization
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Legal Business Name | KYLE HAZELWOOD MD PLLC
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Dates
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Enumeration Date | 06/12/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 825 SE BISHOP BLVD STE 120
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City | PULLMAN
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State | WA
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Zip | 99163-5517
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Country | US
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Telephone | 509-332-2828
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Fax |
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Provider Business Mailing Address
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Address Line | 825 SE BISHOP BLVD STE 120
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City | PULLMAN
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State | WA
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Zip | 99163-5517
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Country | US
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Telephone | 509-332-2828
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. KYLE HAZELWOOD
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Credential | MD
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Telephone | 509-332-2828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number |
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License Number State |
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