Provider Demographics
NPI:1245356187
Name:LAFRANCE, RUSSELL MATTHEW (MD)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:MATTHEW
Last Name:LAFRANCE
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 1:1808 GORTON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NY
Mailing Address - Zip Code:13346-2408
Mailing Address - Country:US
Mailing Address - Phone:315-824-1250
Mailing Address - Fax:315-824-2033
Practice Address - Street 1:85 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NY
Practice Address - Zip Code:13346-1227
Practice Address - Country:US
Practice Address - Phone:315-824-1250
Practice Address - Fax:315-824-2033
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY268732207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03687794Medicaid
268732OtherNYS MEDICAL LICENSE
NY03687794Medicaid