Provider Demographics
NPI:1588856132
Name:LAFON, EVERETTE DARR JR (MD)
Entity Type:Individual
Prefix:
First Name:EVERETTE
Middle Name:DARR
Last Name:LAFON
Suffix:JR
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 1:5000 COX RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9263
Mailing Address - Country:US
Mailing Address - Phone:804-968-5700
Mailing Address - Fax:
Practice Address - Street 1:5900 CEDAR LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3635
Practice Address - Country:US
Practice Address - Phone:443-718-4067
Practice Address - Fax:443-718-4068
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0068795207P00000X, 207P00000X
FLTRN11750390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD160968YVZMedicare PIN
MD268054YWV2Medicare UPIN
MD160968ZDDBMedicare UPIN