Healthcare Provider Details

I. General information

NPI: 1124148895
Provider Name (Legal Business Name): JEFFREY CHARLES LAFRANCE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 BREWSTER RD
BRISTOL CT
06010-5161
US

IV. Provider business mailing address

75 NORTHINGTON DR
AVON CT
06001-2355
US

V. Phone/Fax

Practice location:
  • Phone: 860-585-3433
  • Fax:
Mailing address:
  • Phone: 860-675-7571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number033120
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: