Provider Demographics
NPI:1396789269
Name:HAZLEWOOD, JEFFREY E (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:E
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 1:100 PHYSICIANS WAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37090-8102
Mailing Address - Country:US
Mailing Address - Phone:615-453-4045
Mailing Address - Fax:615-444-5579
Practice Address - Street 1:100 PHYSICIANS WAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8102
Practice Address - Country:US
Practice Address - Phone:615-444-3307
Practice Address - Fax:615-444-5579
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000027823208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3800495Medicaid
TN4121917OtherBCBS
TN3800495Medicare PIN
TN4121917OtherBCBS