Individual
DR. SUSAN MOORE HAEFNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 N BEAVER ST, FLAGSTAFF, AZ 86001-3118
(928) 773-2120
(928) 213-2189
Mailing address
1200 N BEAVER ST, PAYER CREDENTIALING, FLAGSTAFF, AZ 86001-3118
(928) 773-2559
(928) 213-6292
Taxonomy
Speciality
Code
Description
License number
State
2080P0203X
Pediatric Critical Care Medicine Physician
Primary
27097
AZ
2080P0203X
Pediatric Critical Care Medicine Physician
L4961
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
152394601
—
TX
05
—
705347
—
AZ
Enumeration date
06/08/2006
Last updated
12/18/2015
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