Provider Demographics
NPI:1679513774
Name:HAFT, LAWRENCE R (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:R
Last Name:HAFT
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 1:12728 19TH AVE SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6526
Mailing Address - Country:US
Mailing Address - Phone:425-225-2700
Mailing Address - Fax:425-225-2790
Practice Address - Street 1:12728 19TH AVE SE
Practice Address - Street 2:SUITE 200
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6526
Practice Address - Country:US
Practice Address - Phone:425-225-2700
Practice Address - Fax:425-225-2790
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024244207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8105744Medicaid
WAMD00024244OtherSTATE LICENSE NUMBER
WA0075983OtherLABOR AND INDUSTRY
WA060062231OtherRAILRAOD MEDICARE
A09333Medicare UPIN
WA8105744Medicaid