Provider Demographics
NPI:1275882524
Name:HAFEN, LEE RUSSELL (MD)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:RUSSELL
Last Name:HAFEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4708 ALLIANCE BLVD STE 540
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5339
Mailing Address - Country:US
Mailing Address - Phone:469-800-6200
Mailing Address - Fax:469-800-6210
Practice Address - Street 1:4708 ALLIANCE BLVD STE 540
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5339
Practice Address - Country:US
Practice Address - Phone:469-800-6200
Practice Address - Fax:469-800-6210
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2021-09-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXR9767208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)