Provider Demographics
NPI:1811938152
Name:HATFIELD, KENT M (DO)
Entity type:Individual
Prefix:DR
First Name:KENT
Middle Name:M
Last Name:HATFIELD
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 1:3331 E BASELINE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85234-2633
Mailing Address - Country:US
Mailing Address - Phone:480-964-1600
Mailing Address - Fax:480-833-7640
Practice Address - Street 1:3331 E BASELINE RD
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85234-2633
Practice Address - Country:US
Practice Address - Phone:480-964-1600
Practice Address - Fax:480-833-7640
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2754207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ147620001Medicaid
AZ080131963OtherRAILROAD
AZ1Z1018OtherHEALTH NET AZ
AZAZ0392550OtherBCBS
AZ526610254OtherTRICARE
AZF67674Medicare UPIN
AZ1Z1018OtherHEALTH NET AZ