Individual
BRENT PHILIP HAZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4451 BAYOU BLVD, PENSACOLA, FL 32503-2601
(850) 416-7619
(850) 416-7753
Mailing address
PO BOX 2699, ATTN: SHMG/HPE, PENSACOLA, FL 32513-2699
(850) 416-7619
(850) 416-7753
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MT196193
PA
207R00000X
Internal Medicine Physician
57.017460
OH
207R00000X
Internal Medicine Physician
ME114426
FL
208M00000X
Hospitalist Physician
Primary
ME114426
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0095096-00
—
FL
01
—
14PV8
BCBS
FL
Enumeration date
07/21/2009
Last updated
04/18/2016
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