Provider Demographics
NPI:1659352367
Name:HAZEN, PAUL GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:GREGORY
Last Name:HAZEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:26908 DETROIT RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2398
Mailing Address - Country:US
Mailing Address - Phone:440-482-8323
Mailing Address - Fax:440-808-1606
Practice Address - Street 1:26908 DETROIT RD
Practice Address - Street 2:SUITE 103
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2398
Practice Address - Country:US
Practice Address - Phone:440-482-8323
Practice Address - Fax:440-808-1606
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH037749207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0356092Medicaid
OH0356092Medicaid
A76277Medicare UPIN