Provider Demographics
NPI:1659373231
Name:LAFON, FAY ANNETTE (MD)
Entity Type:Individual
Prefix:DR
First Name:FAY
Middle Name:ANNETTE
Last Name:LAFON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-1139
Mailing Address - Country:US
Mailing Address - Phone:505-525-3531
Mailing Address - Fax:505-525-3534
Practice Address - Street 1:2611 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-1139
Practice Address - Country:US
Practice Address - Phone:505-525-3531
Practice Address - Fax:505-525-3534
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM83-66207Q00000X, 2080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM19254OtherPRESBYTERIAN SALUD
NMNM009103OtherNM BLUE CROSS BLUE SHIELD
NM24968Medicaid
NMNM009103OtherNM BLUE CROSS BLUE SHIELD