Provider Demographics
NPI:1477540359
Name:LAFOND, NICHOLAS PAUL (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:PAUL
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 1:916 SAINT PETER ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:MN
Mailing Address - Zip Code:55328-2813
Mailing Address - Country:US
Mailing Address - Phone:763-972-9172
Mailing Address - Fax:763-972-7234
Practice Address - Street 1:916 SAINT PETER ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:MN
Practice Address - Zip Code:55328-2813
Practice Address - Country:US
Practice Address - Phone:763-972-9172
Practice Address - Fax:763-972-7234
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28529207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN001380300Medicaid
MN001380300Medicaid