Basic Information
| Provider Information | |||||||||
| NPI: | 1205823887 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFER | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10901 GRANADA LN | ||||||||
| Address2: | STE.200 | ||||||||
| City: | OVERLAND PARK | ||||||||
| State: | KS | ||||||||
| PostalCode: | 662111401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9136601616 | ||||||||
| FaxNumber: | 9136601664 | ||||||||
| Practice Location | |||||||||
| Address1: | 17065 S 71 HIGHWAY | ||||||||
| Address2: | |||||||||
| City: | BELTON | ||||||||
| State: | MO | ||||||||
| PostalCode: | 64012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163481200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2005 | ||||||||
| LastUpdateDate: | 01/29/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 100308 | MO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | 04-29021 | KS | N | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 203379615 | 05 | MO | MEDICAID | P00357734 | 01 | MO | RR MCR | OTHER | 905660 | 01 | FIRST HEALTH | OTHER | 100453630 B | 05 | KS | MEDICAID | 4207454 | 01 | AETNA | OTHER | 100453630C | 05 | KS | MEDICAID | 18213033 | 01 | BCBS | OTHER |