Provider Demographics
NPI:1902066731
Name:LAFOUNTAINE, SCOTT (SF-IDC)
Entity type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:LAFOUNTAINE
Suffix:
Gender:M
Credentials:SF-IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1840 COVE ROAD
Mailing Address - Street 2:NAVAL SPECIAL WARFARE GROUP TWO MEDICAL DEPARTMENT
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23521-2100
Mailing Address - Country:US
Mailing Address - Phone:757-462-3025
Mailing Address - Fax:757-462-4013
Practice Address - Street 1:1840 COVE ROAD
Practice Address - Street 2:NAVAL SPECIAL WARFARE GROUP TWO MEDICAL DEPARTMENT
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-2100
Practice Address - Country:US
Practice Address - Phone:757-462-3025
Practice Address - Fax:757-462-4013
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman