Healthcare Provider Details

I. General information

NPI: 1962629881
Provider Name (Legal Business Name): PIERRE RICHARD LAFONTANT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 S MIAMI AVE
MIAMI FL
33133-4253
US

IV. Provider business mailing address

7741 SW 177TH ST
VILLAGE OF PALMETTO BAY FL
33157-6254
US

V. Phone/Fax

Practice location:
  • Phone: 305-285-2191
  • Fax:
Mailing address:
  • Phone: 305-259-1511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License NumberME 58228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: