Provider Demographics
NPI:1619641636
Name:HAFEN, TYRONE TROY
Entity Type:Individual
Prefix:
First Name:TYRONE
Middle Name:TROY
Last Name:HAFEN
Suffix:
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 1:230 N 1680 E STE D1
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-2576
Mailing Address - Country:US
Mailing Address - Phone:435-610-1696
Mailing Address - Fax:
Practice Address - Street 1:230 N 1680 E STE D1
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-2576
Practice Address - Country:US
Practice Address - Phone:435-610-1696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist