Individual
TAMARA LOEWEN HAZBUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1116 N 16TH ST, LAFAYETTE, IN 47904-2119
(765) 448-8000
(765) 448-8337
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01061453A
IN
207Q00000X
Family Medicine Physician
Primary
01061453A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000378691
ANTHEM BCBS
—
01
—
000000585375
ANTHEM PROVIDER NUMBER
IN
01
—
000000681128
ANTHEM PROVIDER NUMBER / URGENT CARE SERVICES
IN
05
—
200917610
—
IN
Enumeration date
12/19/2005
Last updated
01/13/2021
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