1548249766 NPI number — DR. ERIC SHAWN HAZELRIGG M.D.

Table of content: MRS. KELLY OCONNOR RICHERT (NPI 1447599857)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548249766 NPI number — DR. ERIC SHAWN HAZELRIGG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HAZELRIGG
Provider First Name:
ERIC
Provider Middle Name:
SHAWN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548249766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1760 E PECOS RD STE 235
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GILBERT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85295-3207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-813-0944
Provider Business Mailing Address Fax Number:
480-813-0038

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1760 E PECOS RD STE 235
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GILBERT
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85295-3207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-813-0944
Provider Business Practice Location Address Fax Number:
480-813-0038
Provider Enumeration Date:
01/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  20772 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 99081 . This is a "PACIFICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 1Z1555 . This is a "HEALTHNET" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 3336256 . This is a "CIGNA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 0700208 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 163684 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 49453 . This is a "MAYO HEALTH PLAN" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 2008183 . This is a "AETNA" identifier , issued by the state of ( AS ) . This identifiers is of the category "OTHER".
  • Identifier: AZ0874980 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: POB13HAZEER1 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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