Healthcare Provider Details

I. General information

NPI: 1063483139
Provider Name (Legal Business Name): DANIEL HAFENRICHTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3009 N BALLAS RD STE 320A
SAINT LOUIS MO
63131-2324
US

IV. Provider business mailing address

3009 N BALLAS RD STE 320A
SAINT LOUIS MO
63131-2324
US

V. Phone/Fax

Practice location:
  • Phone: 314-996-7882
  • Fax: 314-569-7135
Mailing address:
  • Phone: 314-996-7882
  • Fax: 314-569-7135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number103467
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: