Provider Demographics
NPI:1093987042
Name:R MARK HAZEL PA
Entity Type:Organization
Organization Name:R MARK HAZEL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:R
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HAZEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-463-4313
Mailing Address - Street 1:6701 HERITAGE PKWY STE 170
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-8798
Mailing Address - Country:US
Mailing Address - Phone:972-463-4313
Mailing Address - Fax:972-463-4245
Practice Address - Street 1:6701 HERITAGE PKWY STE 170
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8798
Practice Address - Country:US
Practice Address - Phone:972-463-4313
Practice Address - Fax:972-463-4245
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0025NAOtherBCBS
TX00Y783Medicare PIN