Provider Demographics
NPI:1306952056
Name:HAFEN, MARK K (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:K
Last Name:HAFEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:226 N 1100 E STE A
Mailing Address - Street 2:
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-2054
Mailing Address - Country:US
Mailing Address - Phone:801-855-3844
Mailing Address - Fax:801-855-3854
Practice Address - Street 1:226 N 1100 E STE A
Practice Address - Street 2:
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-2054
Practice Address - Country:US
Practice Address - Phone:801-855-3848
Practice Address - Fax:801-855-3854
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT5960243-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT000066143Medicare PIN