Provider Demographics
NPI:1639129885
Name:LAFRENTZ, JOHN R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:R
Last Name:LAFRENTZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:285 CHATEAU DR
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6401
Mailing Address - Country:US
Mailing Address - Phone:256-882-0165
Mailing Address - Fax:256-882-7846
Practice Address - Street 1:285 CHATEAU DR
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6401
Practice Address - Country:US
Practice Address - Phone:256-882-0165
Practice Address - Fax:256-882-7846
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00023611207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
51521796OtherBCBS
51521796OtherBCBS
051521796LAFMedicare ID - Type Unspecified