MEDICARE: DONALD LAFONT MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD5107	TN

General Provider Information

NPI Number	:	1124475371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD LAFONT MD

Provider Business Mailing Address
First Line	:	331 EDENWOOD DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3432
Country	:	US
Telephone Number	:	731-513-3088
Fax Number	:

Provider Business Practice Location Address
First Line	:	331 EDENWOOD DR
Second Line	:
City	:	JACKSON
State	:	TN
Zip	:	38301-3432
Country	:	US
Telephone Number	:	731-513-3088
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2016
Last Update Date	:	05/18/2016

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