Basic Information
| Provider Information | |||||||||
| NPI: | 1144456179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PETER LAFON, DO, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1326 | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740231326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Practice Location | |||||||||
| Address1: | 2340 E MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CUSHING | ||||||||
| State: | OK | ||||||||
| PostalCode: | 740232905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182256904 | ||||||||
| FaxNumber: | 9182254559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2009 | ||||||||
| LastUpdateDate: | 08/11/2009 | ||||||||
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| AuthorizedOfficialLastName: | LAFON | ||||||||
| AuthorizedOfficialFirstName: | PETER | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9182256904 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 2537 | OK | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 200251330A | 05 | OK | MEDICAID |