Basic Information
| Provider Information | |||||||||
| NPI: | 1811165608 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HAFNER | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 OAK RIDGE TPKE | ||||||||
| Address2: | STE C100 | ||||||||
| City: | OAK RIDGE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 378306927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8654832288 | ||||||||
| FaxNumber: | 8654824400 | ||||||||
| Practice Location | |||||||||
| Address1: | 3605 EXECUTIVE DR | ||||||||
| Address2: | |||||||||
| City: | SAN ANGELO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 769046884 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3259499555 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/14/2008 | ||||||||
| LastUpdateDate: | 05/12/2016 | ||||||||
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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 | 207Y00000X | 50510 | MN | Y | Allopathic & Osteopathic Physicians | Otolaryngology | 207Y00000X | 53596 | TN | N | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.