Provider Demographics
NPI:1285600445
Name:LAFORTUNE, RACHEL E (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:E
Last Name:LAFORTUNE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:E
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:405-951-2541
Mailing Address - Fax:405-951-2237
Practice Address - Street 1:3300 NW EXPRESSWAY ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-4418
Practice Address - Country:US
Practice Address - Phone:405-951-2541
Practice Address - Fax:405-951-2237
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-104767207P00000X
OK25247207P00000X
GA058949207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL88828Medicare ID - Type Unspecified
ILH50672Medicare UPIN