Provider Demographics
NPI:1124689377
Name:HAZLEWOOD, CASEY LANE (MD)
Entity type:Individual
Prefix:
First Name:CASEY
Middle Name:LANE
Last Name:HAZLEWOOD
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 1:820 MAIN LANE
Mailing Address - Street 2:SUITE 1111
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801
Mailing Address - Country:US
Mailing Address - Phone:304-888-2622
Mailing Address - Fax:
Practice Address - Street 1:52 W UNDERWOOD ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1110
Practice Address - Country:US
Practice Address - Phone:321-841-8933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29599207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty