Provider Demographics
NPI:1285106096
Name:LAFLEUR, JAMES R (PA-C)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:LAFLEUR
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 1:677 CATHEDRAL DR STE 240
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-7389
Mailing Address - Country:US
Mailing Address - Phone:605-755-4150
Mailing Address - Fax:
Practice Address - Street 1:677 CATHEDRAL DR STE 240
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-7389
Practice Address - Country:US
Practice Address - Phone:605-755-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILPENDING363A00000X
MI5601008908363A00000X
WAPA61094742363AS0400X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical