Provider Demographics
NPI:1720075229
Name:HAFFORD, ROBERT KELLOGG (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:KELLOGG
Last Name:HAFFORD
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 1:700 BORTON AVE
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-3110
Mailing Address - Country:US
Mailing Address - Phone:989-894-2926
Mailing Address - Fax:989-894-2499
Practice Address - Street 1:700 BORTON AVE
Practice Address - Street 2:
Practice Address - City:ESSEXVILLE
Practice Address - State:MI
Practice Address - Zip Code:48732-3110
Practice Address - Country:US
Practice Address - Phone:989-894-2926
Practice Address - Fax:989-894-2499
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2009-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI042306207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine