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General NPI Number Information
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NPI Number | 1093162596
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Entity Type | Individual
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Provider Name | JUSTIN JUDD LAFRANCE D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2016
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Last Update Date | 01/02/2019
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Provider Practice Location Address
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Address Line | 6500 38TH AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-1629
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Country | US
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Telephone | 843-321-7643
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Fax |
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Provider Business Mailing Address
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Address Line | 4088 71ST TER N
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City | PINELLAS PARK
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State | FL
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Zip | 33781-4421
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Country | US
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Telephone | 843-321-7643
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 5101023178
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License Number State | MI
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