Provider Demographics
NPI:1235620212
Name:HAZLEY, MALIK JON (MD)
Entity Type:Individual
Prefix:
First Name:MALIK
Middle Name:JON
Last Name:HAZLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1611 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-5847
Mailing Address - Country:US
Mailing Address - Phone:347-909-1444
Mailing Address - Fax:
Practice Address - Street 1:211 HERITAGE PARK DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1557
Practice Address - Country:US
Practice Address - Phone:615-890-9006
Practice Address - Fax:615-494-5454
Is Sole Proprietor?:No
Enumeration Date:2018-05-24
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN64319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine