Provider Demographics
NPI:1568448876
Name:HAZBUN, TAMARA LOEWEN (MD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:LOEWEN
Last Name:HAZBUN
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 1:1200 W WHITE RIVER BLVD
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47303-4988
Mailing Address - Country:US
Mailing Address - Phone:877-668-5621
Mailing Address - Fax:
Practice Address - Street 1:1116 N 16TH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2119
Practice Address - Country:US
Practice Address - Phone:765-448-8000
Practice Address - Fax:765-448-8337
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01061453A207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000681128OtherANTHEM PROVIDER NUMBER / URGENT CARE SERVICES
IN000000585375OtherANTHEM PROVIDER NUMBER
000000378691OtherANTHEM BCBS
IN200917610Medicaid
IN815500N9Medicare PIN
INP00732727Medicare PIN
000000378691OtherANTHEM BCBS