Provider Demographics
NPI:1598740326
Name:CEBRUN-ARCHIE, HAZEL C (MD)
Entity Type:Individual
Prefix:
First Name:HAZEL
Middle Name:C
Last Name:CEBRUN-ARCHIE
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:PO BOX 200993
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77216-0993
Mailing Address - Country:US
Mailing Address - Phone:281-784-1111
Mailing Address - Fax:281-784-1555
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082
Practice Address - Country:US
Practice Address - Phone:281-799-8600
Practice Address - Fax:281-596-5947
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3257207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX154929702Medicaid
TX8F9294OtherBCBSTX PROV NO
TX154929701Medicaid
TX1598740326OtherTRICARE SOUTH
TX1598740326OtherBCBSTX
TX930126399Medicare PIN
TX1598740326OtherTRICARE SOUTH
TX1598740326OtherBCBSTX
TXH51459Medicare UPIN
TX154929702Medicaid