Provider Demographics
NPI:1093818031
Name:HAFFNER, JONATHAN DAVID (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:DAVID
Last Name:HAFFNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3116 MEDICAL PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:CARTHAGE
Mailing Address - State:MO
Mailing Address - Zip Code:64836-3059
Mailing Address - Country:US
Mailing Address - Phone:417-358-7574
Mailing Address - Fax:
Practice Address - Street 1:3116 MEDICAL PARK DRIVE
Practice Address - Street 2:
Practice Address - City:CARTHAGE
Practice Address - State:MO
Practice Address - Zip Code:64836-3059
Practice Address - Country:US
Practice Address - Phone:417-358-7574
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008016018207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine