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General NPI Number Information
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NPI Number | 1720399280
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Entity Type | Individual
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Provider Name | MARTIN J LAFOLLETTE D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 10/23/2019
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Provider Practice Location Address
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Address Line | 10180 W HAPPY VALLEY RD STE 100
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City | PEORIA
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State | AZ
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Zip | 85383-1389
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Country | US
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Telephone | 623-561-3000
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Fax | 623-561-3009
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Provider Business Mailing Address
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Address Line | 2303 N 390 E
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City | PROVO
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State | UT
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Zip | 84604-1733
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Country | US
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Telephone | 800-997-6196
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10776
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OC-0010
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MED-PHYS-LIC-61129
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License Number State | MT
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 25516
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OP60826527
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 05-40628
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License Number State | KS
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Taxonomy #7
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CL0017
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License Number State | NV
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Taxonomy #8
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 63228
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License Number State | MN
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Taxonomy #9
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO-05136
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License Number State | IA
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Taxonomy #10
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 10663123-1204
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License Number State | UT
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Taxonomy #11
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1772
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License Number State | NE
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Taxonomy #12
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DO.1788
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License Number State | AL
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Taxonomy #13
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CDR.0000063
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License Number State | CO
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Taxonomy #14
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13-321
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License Number State | WI
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Taxonomy #15
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 006138
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License Number State | AZ
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