Provider Demographics
NPI:1700949369
Name:HAZBOUN, RAMSEY R (MD)
Entity Type:Individual
Prefix:DR
First Name:RAMSEY
Middle Name:R
Last Name:HAZBOUN
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 1:311 MCCLINTOCK DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932
Mailing Address - Country:US
Mailing Address - Phone:915-842-9622
Mailing Address - Fax:915-842-8619
Practice Address - Street 1:311 MCCLONTOCK DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932
Practice Address - Country:US
Practice Address - Phone:915-842-8622
Practice Address - Fax:915-842-8619
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2343207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX194336702Medicaid
TXTXB108263Medicare PIN