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Individual

MICHAEL WAYNE HAFNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
P.A.

Contact information

Practice address
511 WINDSOR DR, STILLWATER, OK 74074-6962
(405) 707-0900
(405) 707-3363
Mailing address
511 WINDSOR DR, STILLWATER, OK 74074-6962
(405) 707-0900
(405) 707-3363

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1771
OK

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1771
STATE LICENSE
OK
05
200219760A
OK
Enumeration date
09/10/2008
Last updated
01/30/2009
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