Provider Demographics
NPI:1184687972
Name:MAYFIELD, CORNELIUS LAFFITTE (MD)
Entity type:Individual
Prefix:
First Name:CORNELIUS
Middle Name:LAFFITTE
Last Name:MAYFIELD
Suffix:
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 1:7777 HENNESSY BLVD
Mailing Address - Street 2:STE 102
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4300
Mailing Address - Country:US
Mailing Address - Phone:225-214-4300
Mailing Address - Fax:225-214-4303
Practice Address - Street 1:7777 HENNESSY BLVD
Practice Address - Street 2:STE 102
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4300
Practice Address - Country:US
Practice Address - Phone:225-214-4300
Practice Address - Fax:225-214-4303
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA12328R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1698989Medicaid
LA1698989Medicaid
5Y686CB57Medicare ID - Type Unspecified