Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | G8171 | TX |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | G8171 | TX |
N | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | G8171 | TX |
NPI | 1689637209 |
---|---|
Provider Name | Dr. Sandra Jo Hazelip |
First Address | Abilene, TX 79605 |
Second Address | Abilene, TX 79605 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 10/12/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
120549406 | (05) | TX |
C16743 | (02) |