Provider Demographics
NPI:1669793006
Name:HAFERNICK, ANGELA CASKEY (MD)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:CASKEY
Last Name:HAFERNICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 GENE SAMFORD DR STE B
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3376
Mailing Address - Country:US
Mailing Address - Phone:936-634-3396
Mailing Address - Fax:936-634-4398
Practice Address - Street 1:206 GENE SAMFORD DR STE B
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3376
Practice Address - Country:US
Practice Address - Phone:936-634-3396
Practice Address - Fax:936-634-4398
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP0596207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine