Individual
DR. WILLIAM HAZLE
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(972) 420-8345
(972) 420-7770
Mailing address
500 S 11TH AVE, POCATELLO, ID 83201-4835
(972) 420-8345
(972) 420-7770
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
M-8594
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
50062
BC&BS
ID
Enumeration date
03/29/2006
Last updated
07/09/2007
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