Provider Demographics
NPI:1164463550
Name:HAFTEL, ANTHONY J (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:J
Last Name:HAFTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12228 59TH AVE NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8128
Mailing Address - Country:US
Mailing Address - Phone:253-229-0579
Mailing Address - Fax:253-858-2218
Practice Address - Street 1:1717 S I ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-5031
Practice Address - Country:US
Practice Address - Phone:253-426-6898
Practice Address - Fax:253-426-6963
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015514207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8160293Medicaid
WA8160293Medicaid
WA8853921Medicare ID - Type Unspecified