Provider Demographics
NPI:1477568061
Name:HAZELRIG, PAUL E JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:E
Last Name:HAZELRIG
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 N SAN MATEO DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2889
Mailing Address - Country:US
Mailing Address - Phone:650-342-0854
Mailing Address - Fax:650-342-2198
Practice Address - Street 1:77 N SAN MATEO DR
Practice Address - Street 2:SUITE 1
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2889
Practice Address - Country:US
Practice Address - Phone:650-342-0854
Practice Address - Fax:650-342-2198
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24229174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA23860Medicare UPIN