Provider Demographics
NPI:1417914961
Name:HAZELWOOD, DARCI RENEE (DO)
Entity Type:Individual
Prefix:DR
First Name:DARCI
Middle Name:RENEE
Last Name:HAZELWOOD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:DARCI
Other - Middle Name:R
Other - Last Name:HAZELWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1717 S UTICA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-5346
Mailing Address - Country:US
Mailing Address - Phone:918-748-1300
Mailing Address - Fax:918-748-1303
Practice Address - Street 1:1717 S UTICA AVE STE A
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-5346
Practice Address - Country:US
Practice Address - Phone:918-748-1300
Practice Address - Fax:918-748-1303
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4193207Q00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200215950AMedicaid
OK200215950AMedicaid