Provider Demographics
NPI:1922169622
Name:HAZARD, GERALD W (MD)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:W
Last Name:HAZARD
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:PO BOX 1413
Mailing Address - Street 2:
Mailing Address - City:WELLFLEET
Mailing Address - State:MA
Mailing Address - Zip Code:02667-0526
Mailing Address - Country:US
Mailing Address - Phone:508-240-0208
Mailing Address - Fax:508-240-0499
Practice Address - Street 1:OUTER CAPE HEALTH SERVICES INC.
Practice Address - Street 2:3130 STATE HIGHWAY, ROUTE 6
Practice Address - City:WELLFLEET
Practice Address - State:MA
Practice Address - Zip Code:02667
Practice Address - Country:US
Practice Address - Phone:508-349-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA27683208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics