Provider Demographics
NPI:1760609192
Name:HAZELWOOD, SCOTT (DO)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:HAZELWOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:793 EASTERN BYPASS
Mailing Address - Street 2:SUITE 110
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475
Mailing Address - Country:US
Mailing Address - Phone:859-624-2020
Mailing Address - Fax:859-623-7362
Practice Address - Street 1:793 EASTERN BYP
Practice Address - Street 2:SUITE 110
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2422
Practice Address - Country:US
Practice Address - Phone:888-732-4293
Practice Address - Fax:859-623-7362
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03083208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics