Provider Demographics
NPI:1255483277
Name:HAFRON, JASON M (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:M
Last Name:HAFRON
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:20952 E 12 MILE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48081-3200
Mailing Address - Country:US
Mailing Address - Phone:586-771-4820
Mailing Address - Fax:586-771-6620
Practice Address - Street 1:6900 ORCHARD LAKE RD STE 300
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48322-3405
Practice Address - Country:US
Practice Address - Phone:248-539-9036
Practice Address - Fax:248-539-9267
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-10-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301089630208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MII68437OtherHAP
MIP00419406OtherRAILROAD MEDICARE
MI7828814OtherAETNA
MI01007605OtherHEALTH PLUS
MI7828814OtherAETNA
MII68437OtherHAP
MIP00419406OtherRAILROAD MEDICARE