Healthcare Provider Details

I. General information

NPI: 1265521835
Provider Name (Legal Business Name): STEVEN MARK HAFFNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7703 FLOYD CURL DR MC 7873
SAN ANTONIO TX
78229-3901
US

IV. Provider business mailing address

202 POST OAK WAY
SHAVANO PARK TX
78230-5615
US

V. Phone/Fax

Practice location:
  • Phone: 210-567-4722
  • Fax:
Mailing address:
  • Phone: 210-492-5018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License NumberG1670
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: