Provider Demographics
NPI:1134474752
Name:HAEFFNER, ADAM (PA-C)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:
Last Name:HAEFFNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 N CIRCLE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1182
Mailing Address - Country:US
Mailing Address - Phone:719-228-9440
Mailing Address - Fax:719-228-9061
Practice Address - Street 1:3010 N CIRCLE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1182
Practice Address - Country:US
Practice Address - Phone:719-228-9440
Practice Address - Fax:719-228-9061
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant