Provider Demographics
NPI:1003241449
Name:SCOTT L. HAZELWOOD, DO
Entity Type:Organization
Organization Name:SCOTT L. HAZELWOOD, DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAZELWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-623-3131
Mailing Address - Street 1:PO BOX 34166
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-4166
Mailing Address - Country:US
Mailing Address - Phone:859-623-3131
Mailing Address - Fax:260-407-8009
Practice Address - Street 1:801 EASTERN BYP
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2751
Practice Address - Country:US
Practice Address - Phone:859-623-3131
Practice Address - Fax:260-407-8009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-04
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty