Provider Demographics
NPI:1689642720
Name:LAFON, PETER (DO)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:LAFON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 E CHERRY
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-4102
Mailing Address - Country:US
Mailing Address - Phone:918-225-0616
Mailing Address - Fax:918-225-3740
Practice Address - Street 1:2340 E MAIN ST
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-2905
Practice Address - Country:US
Practice Address - Phone:918-225-6904
Practice Address - Fax:918-225-4559
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2537208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100135530AMedicaid
OK100135530AMedicaid