Provider Demographics
NPI:1083686646
Name:LAFATA, JOHN ANTHONY (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ANTHONY
Last Name:LAFATA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 HOSPITAL DR STE 9
Mailing Address - Street 2:
Mailing Address - City:CLYDE
Mailing Address - State:NC
Mailing Address - Zip Code:28721-8046
Mailing Address - Country:US
Mailing Address - Phone:828-452-0331
Mailing Address - Fax:828-456-6100
Practice Address - Street 1:600 HOSPITAL DR
Practice Address - Street 2:SUITE 9
Practice Address - City:CLYDE
Practice Address - State:NC
Practice Address - Zip Code:28721-8024
Practice Address - Country:US
Practice Address - Phone:828-452-0331
Practice Address - Fax:828-456-8726
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9801692207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891172LMedicaid
G84875Medicare UPIN