Provider Demographics
NPI:1356348742
Name:LAFOND, WILDER KEITH (CPO)
Entity type:Individual
Prefix:MR
First Name:WILDER
Middle Name:KEITH
Last Name:LAFOND
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:68 SWEETEN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-2318
Mailing Address - Country:US
Mailing Address - Phone:828-274-2400
Mailing Address - Fax:828-277-4808
Practice Address - Street 1:639 BILTMORE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-2585
Practice Address - Country:US
Practice Address - Phone:828-254-3392
Practice Address - Fax:828-254-4380
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795380Medicaid