Provider Demographics
NPI:1205823887
Name:HAFER, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:EDWARD
Last Name:HAFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 GRANADA LN
Mailing Address - Street 2:STE.200
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1401
Mailing Address - Country:US
Mailing Address - Phone:913-660-1616
Mailing Address - Fax:913-660-1664
Practice Address - Street 1:17065 S 71 HIGHWAY
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012
Practice Address - Country:US
Practice Address - Phone:816-348-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO100308207R00000X
KS04-29021207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO203379615Medicaid
MOP00357734OtherRR MCR
905660OtherFIRST HEALTH
KS100453630 BMedicaid
4207454OtherAETNA
KS100453630CMedicaid
18213033OtherBCBS
B81350Medicare UPIN
KS100453630 BMedicaid
MOI143187BMedicare PIN
MO203379615Medicaid