Individual
TODD HAZELTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
101 MANNING DR, CHAPEL HILL, NC 27514-4220
(984) 974-1000
Mailing address
PO BOX 917770, ORLANDO, FL 32891-0001
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2022-01137
NC
2085R0202X
Diagnostic Radiology Physician
ME70046
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253763000
—
FL
01
—
42740
BLUE CROSS BLUE SHIELD
FL
Enumeration date
08/01/2006
Last updated
06/03/2022
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