Healthcare Provider Details

I. General information

NPI: 1730186420
Provider Name (Legal Business Name): MAURY DANIEL HAFERMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

IV. Provider business mailing address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

V. Phone/Fax

Practice location:
  • Phone: 509-548-3420
  • Fax: 509-548-1605
Mailing address:
  • Phone: 509-548-3420
  • Fax: 509-548-1605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD00037297
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: