Healthcare Provider Details

I. General information

NPI: 1841209954
Provider Name (Legal Business Name): GEORGE I LAFON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 10/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W FLORIDA ST
DEMING NM
88030-4558
US

IV. Provider business mailing address

905S 8TH ST
DEMING NM
88030-4037
US

V. Phone/Fax

Practice location:
  • Phone: 575-544-2800
  • Fax: 575-544-2801
Mailing address:
  • Phone: 575-543-7208
  • Fax: 575-543-7250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number81-71
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: