Provider Demographics
NPI:1023075009
Name:HAFTER, LANCE ELIOT (DO)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ELIOT
Last Name:HAFTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4608 WESTBURY DR
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4265
Mailing Address - Country:US
Mailing Address - Phone:817-929-0275
Mailing Address - Fax:
Practice Address - Street 1:120 E HARRIS AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-5904
Practice Address - Country:US
Practice Address - Phone:325-481-2104
Practice Address - Fax:325-659-0180
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2063207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CS002OtherBCBS
TXD86917Medicare UPIN
TX8G5340Medicare ID - Type Unspecified