Provider Demographics
NPI:1912973116
Name:HAZARD, ROBERT D (PA C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:HAZARD
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:515 HOSPITAL DRIVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065
Mailing Address - Country:US
Mailing Address - Phone:502-633-3525
Mailing Address - Fax:502-633-9991
Practice Address - Street 1:150 FAIRVIEW COURT
Practice Address - Street 2:
Practice Address - City:EMINENCE
Practice Address - State:KY
Practice Address - Zip Code:40019
Practice Address - Country:US
Practice Address - Phone:502-845-5672
Practice Address - Fax:502-845-1402
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA914363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
7023760OtherAETNA
KY000000386715OtherANTHEM
KY0099315Medicare ID - Type Unspecified
S08887Medicare UPIN
KY000000386715OtherANTHEM