Healthcare Provider Details

I. General information

NPI: 1760296446
Provider Name (Legal Business Name): MARK LAFAVE HAD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 S 24TH ST W UNIT 7
BILLINGS MT
59102-5659
US

IV. Provider business mailing address

2156 N HILL FIELD RD STE 3
LAYTON UT
84041-4771
US

V. Phone/Fax

Practice location:
  • Phone: 406-248-1006
  • Fax: 406-324-9222
Mailing address:
  • Phone: 801-203-4055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD-HAD-LIC-1734
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: