Provider Demographics
NPI:1407950710
Name:HAFFNER, GARY BOYD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BOYD
Last Name:HAFFNER
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:PO BOX 246
Mailing Address - Street 2:745 N. MAIN STREET
Mailing Address - City:CEDARVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:96104
Mailing Address - Country:US
Mailing Address - Phone:530-279-6194
Mailing Address - Fax:530-279-6288
Practice Address - Street 1:132 MEE THEE-UH RD
Practice Address - Street 2:
Practice Address - City:FT. BIDWELL
Practice Address - State:CA
Practice Address - Zip Code:96112
Practice Address - Country:US
Practice Address - Phone:530-279-6115
Practice Address - Fax:530-279-6100
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC39098208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37054Medicare UPIN