Provider Demographics
NPI:1366449480
Name:HAFNER, DONALD PAUL JR
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:PAUL
Last Name:HAFNER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 W 8TH AVE
Mailing Address - Street 2:APT D
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43201-2366
Mailing Address - Country:US
Mailing Address - Phone:614-299-2902
Mailing Address - Fax:
Practice Address - Street 1:30 W 8TH AVE
Practice Address - Street 2:APT D
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-2366
Practice Address - Country:US
Practice Address - Phone:614-299-2902
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2416086171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2416086Medicaid