Provider Demographics
NPI:1518945591
Name:LACANFORA, ROBERT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:
Last Name:LACANFORA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:JOSEPH
Other - Last Name:LACANFORA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-568-7043
Practice Address - Street 1:1600 E JEFFERSON ST
Practice Address - Street 2:STE 510
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5698
Practice Address - Country:US
Practice Address - Phone:206-320-4888
Practice Address - Fax:206-320-4203
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004857363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant