Healthcare Provider Details

I. General information

NPI: 1568857027
Provider Name (Legal Business Name): DAMIAN LAFITTE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2015
Last Update Date: 08/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

511 ASHLAND AVE STE A
WARRENTON MO
63383
US

IV. Provider business mailing address

5510 PERSHING AVE APT 314
SAINT LOUIS MO
63112-1951
US

V. Phone/Fax

Practice location:
  • Phone: 318-456-0543
  • Fax:
Mailing address:
  • Phone: 318-294-6268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number308864
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2018016620
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: