Individual
MR. DENNIS GLENN HAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1040 N MASON RD, DIV SURG UROLOGY, SAINT LOUIS, MO 63141-6399
(314) 362-8200
(833) 210-5713
Mailing address
660 S EUCLID AVE, MSC 8242-22-02, SAINT LOUIS, MO 63110-1010
(314) 362-8200
(833) 210-5713
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
2019043868
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
220090113
—
MO
Enumeration date
06/25/2009
Last updated
11/15/2021
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