Provider Demographics
NPI:1124475371
Name:LAFONT, DONALD (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LAFONT
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 1:331 EDENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3432
Mailing Address - Country:US
Mailing Address - Phone:731-513-3088
Mailing Address - Fax:
Practice Address - Street 1:331 EDENWOOD DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3432
Practice Address - Country:US
Practice Address - Phone:731-513-3088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD5107208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice