Provider Demographics
NPI:1689637209
Name:HAZELIP, SANDRA JO (DO)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:JO
Last Name:HAZELIP
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 SOUTH 27TH
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605
Mailing Address - Country:US
Mailing Address - Phone:325-695-1289
Mailing Address - Fax:325-695-1296
Practice Address - Street 1:3101 SOUTH 27TH
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605
Practice Address - Country:US
Practice Address - Phone:325-695-1289
Practice Address - Fax:325-695-1296
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8171207QG0300X, 207QH0002X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120549406Medicaid
TX8C9178Medicare PIN
TX120549406Medicaid