Individual
DR. GARY ROBERT HAZLETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2401 W UNIVERSITY AVE, MUNCIE, IN 47303-3428
(765) 747-3111
Mailing address
250 N SHADELAND AVE, ATTH: PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01031249A
IN
208M00000X
Hospitalist Physician
Primary
01031249A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100106260A
—
IN
01
—
110085001
MEDICARE RAILROAD
IN
05
—
200986050
—
IN
01
—
P00980457
RR MEDICARE
IN
Enumeration date
10/02/2006
Last updated
02/01/2021
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