MEDICARE: DR. DAVID C HAEFELI M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G3422	TX

General Provider Information

NPI Number	:	1639272636
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID C HAEFELI M.D.

Provider Business Mailing Address
First Line	:	5445 BASSWOOD BLVD
Second Line	:	SUITE 650
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4437
Country	:	US
Telephone Number	:	817-485-0161
Fax Number	:	817-485-9430

Provider Business Practice Location Address
First Line	:	5445 BASSWOOD BLVD
Second Line	:	SUITE 650
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4437
Country	:	US
Telephone Number	:	817-485-0161
Fax Number	:	817-485-9430

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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