Provider Demographics
NPI:1497967376
Name:HAZAN, TAL BEN
Entity Type:Individual
Prefix:DR
First Name:TAL
Middle Name:BEN
Last Name:HAZAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4790 BARKLEY CIR BLDG A
Mailing Address - Street 2:BARKLEY SURGERY CENTER, INC.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-7543
Mailing Address - Country:US
Mailing Address - Phone:239-275-8882
Mailing Address - Fax:239-275-6304
Practice Address - Street 1:4790 BARKLEY CIR BLDG A
Practice Address - Street 2:BARKLEY SURGERY CENTER, INC.
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-7543
Practice Address - Country:US
Practice Address - Phone:239-275-8882
Practice Address - Fax:239-275-6304
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107950207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7646900OtherCIGNA
FL149RSOtherBCBS
FL3059409OtherUHC
FL9439370OtherAETNA
FL7646900OtherCIGNA