Provider Demographics
NPI:1659394146
Name:HAZELTON, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:HAZELTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4055 HWY. 17 SOUTH
Mailing Address - Street 2:P.O. BOX 1919
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576
Mailing Address - Country:US
Mailing Address - Phone:843-652-3939
Mailing Address - Fax:843-652-3939
Practice Address - Street 1:4055 HWY. 17 SOUTH
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576
Practice Address - Country:US
Practice Address - Phone:843-652-3939
Practice Address - Fax:843-652-3939
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22986207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC229862Medicaid
SCP00160285OtherRAILROAD MEDICARE
NC89065C7Medicaid
SCH366067622Medicare PIN
SCP00160285OtherRAILROAD MEDICARE
SCH366066831Medicare PIN