MEDICARE: MARK C HAFNER 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	207L00000X	Anesthesiology Physician	G87487	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00664238	OTHER	CA	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1952382095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C HAFNER M.D.

Provider Business Mailing Address
First Line	:	7417 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3637
Country	:	US
Telephone Number	:	559-436-0871
Fax Number	:	559-436-5221

Provider Business Practice Location Address
First Line	:	1303 E HERNDON AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3309
Country	:	US
Telephone Number	:	559-450-3000
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	09/04/2014

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