Hazel, Tom David
Hazel, Tom David is an individual health care provider with primary practice located at 560 Catalina Dr , Ashland OR 97520-1605. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Family, which is considered as his primary health care specialty. Hazel, Tom David can be contacted via phone (541) 201-4800.Contact Information
Primary practice address
560 Catalina Dr
Ashland OR 97520-1605
Phone: (541) 201-4800
Fax: (541) 201-4815
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Family | 363LF0000X | 083042659 | Oregon |
Profile Details
| NPI number | 1316944754 |
|---|---|
| LBN Legal business name | Hazel, Tom David |
| Credentials | Family Nurse Practitioner (FNP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 30th, 2005 |
| Last updated | May 6th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1316944754 | NPPES |
| Oregon | MEDICAID | 032842 | |
| Oregon | MEDICAID | 136114 |
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