Provider Demographics
NPI:1164467031
Name:LAFOND, YVES JACQUES (MD)
Entity Type:Individual
Prefix:DR
First Name:YVES
Middle Name:JACQUES
Last Name:LAFOND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:451 SOUTH 4TH STREET
Practice Address - Street 2:
Practice Address - City:FULTON
Practice Address - State:NY
Practice Address - Zip Code:13069-2060
Practice Address - Country:US
Practice Address - Phone:315-598-5795
Practice Address - Fax:315-598-7086
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY196878-1174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01559379Medicaid
NY55547BMedicare PIN
NYF96740Medicare UPIN