Provider Demographics
NPI:1740319268
Name:LAFOND, GUY P (MD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:P
Last Name:LAFOND
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 1:220 POINCIANA LN
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-2615
Mailing Address - Country:US
Mailing Address - Phone:727-581-2586
Mailing Address - Fax:727-581-2586
Practice Address - Street 1:220 POINCIANA LN
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2615
Practice Address - Country:US
Practice Address - Phone:727-581-2586
Practice Address - Fax:727-581-2586
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 51822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00250OtherHEALTHEASE
DC214860OtherAVMED
FL370888800Medicaid
DC17855OtherBLUE CROSS BLUE SHIELD
DC17855OtherBLUE CROSS BLUE SHIELD
DCF35696Medicare UPIN
FL17855ZMedicare ID - Type UnspecifiedMEDICARE NUMBER
FLK0073Medicare ID - Type UnspecifiedMEDICARE GROUP #