Provider Demographics
NPI:1053735795
Name:HAFFNER, ROSS
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:HAFFNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7616 DISALLE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-3383
Mailing Address - Country:US
Mailing Address - Phone:888-790-9896
Mailing Address - Fax:260-451-2530
Practice Address - Street 1:7616 DISALLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-3383
Practice Address - Country:US
Practice Address - Phone:888-790-9896
Practice Address - Fax:260-451-2530
Is Sole Proprietor?:No
Enumeration Date:2014-02-18
Last Update Date:2014-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor