Healthcare Provider Details

I. General information

NPI: 1205811528
Provider Name (Legal Business Name): SANDRA GARDNER LAFON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY HOSPITAL NACHRICHTEN KASERNE KARLSRUHER STRASSE 144
HEIDELBERG GERMANY
69126
DE

IV. Provider business mailing address

4477 SOUTH GETTYSBURG 48B
HEIDELBERG GERMANY
69126
DE

V. Phone/Fax

Practice location:
  • Phone: 114-962-2117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number021429
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: