Provider Demographics
NPI:1477633386
Name:HAZARD, LISA JENNIFER (MD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:JENNIFER
Last Name:HAZARD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD STE 350
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:6567 E CARONDELET DR STE 185
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6161
Practice Address - Country:US
Practice Address - Phone:520-546-1778
Practice Address - Fax:520-546-3125
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD612595662085R0001X
UT487300812052085R0205X
AZ424702085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No2085R0205XAllopathic & Osteopathic PhysiciansRadiologyRadiological Physics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ465199Medicaid
Z152234Medicare Oscar/Certification
AZ465199Medicaid