Provider Demographics
NPI:1861449084
Name:HAFER, MARY C (MD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:HAFER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:2971 E COPPER POINT DR
Mailing Address - Street 2:STE # 125
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-5101
Mailing Address - Country:US
Mailing Address - Phone:208-893-5383
Mailing Address - Fax:208-893-5386
Practice Address - Street 1:2971 E COPPER POINT DR
Practice Address - Street 2:STE # 125
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-5101
Practice Address - Country:US
Practice Address - Phone:208-893-5383
Practice Address - Fax:208-893-5386
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
IDM7753207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDM7753OtherIDAHO STATE MEDICAL LICEN
IDM7753OtherIDAHO STATE MEDICAL LICEN