Healthcare Provider Details

I. General information

NPI: 1588644223
Provider Name (Legal Business Name): DANIEL R LALONDE JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 03/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL CENTER DR STE 3L
HAZARD KY
41701-9478
US

IV. Provider business mailing address

200 MEDICAL CENTER DR STE 3L
HAZARD KY
41701-9478
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7951
  • Fax: 606-487-7952
Mailing address:
  • Phone: 606-487-7951
  • Fax: 606-487-7952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number016948
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number49579
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number49579
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: