Provider Demographics
NPI:1992911002
Name:LAFONTANT, RODOLPHE X (MD)
Entity type:Individual
Prefix:
First Name:RODOLPHE
Middle Name:X
Last Name:LAFONTANT
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 1:224 SE 24TH ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32641-7516
Mailing Address - Country:US
Mailing Address - Phone:352-334-7900
Mailing Address - Fax:352-955-2126
Practice Address - Street 1:224 SE 24TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32641-7516
Practice Address - Country:US
Practice Address - Phone:352-334-7900
Practice Address - Fax:352-955-2126
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLACN210251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLACN210OtherLICENSE NUMBER
FLBL9389835OtherDEA NUMBER