# MARY HAFER, MD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1154610731
- **Authorized official:** MICHELE JANEE LOUCAO (OFFICE MANAGER)
- **Authorized official phone:** (208) 893-5383

## Contact information

- **Practice address:** 2971 E COPPER POINT DR, SUITE \# 125, MERIDIAN, ID 83642-5101
- **Practice address phone:** (208) 893-5383
- **Practice address fax:** (208) 893-5386
- **Mailing address:** 2971 E COPPER POINT DR, SUITE \# 125, MERIDIAN, ID 83642-5101
- **Mailing address phone:** (208) 893-5383
- **Mailing address fax:** (208) 893-5386

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 174400000X | Specialist | M-7753 | ID | Yes |
| 363AM0700X | Medical Physician Assistant | PA-895 | ID | — |

## Other

- **Enumeration date:** 04/04/2011
- **Last updated:** 04/04/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | M-7753 | IDAHO STATE MEDICAL LICENSE | ID |