MEDICARE: DR. LAURENCE MILTON PETTY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0068819	FL
2	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	ME0068819	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265655757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENCE MILTON PETTY M.D.

Provider Business Mailing Address
First Line	:	8508 ALAFIA HILLS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3408
Country	:	US
Telephone Number	:	813-650-8600
Fax Number	:	813-650-8664

Provider Business Practice Location Address
First Line	:	8508 ALAFIA HILLS DR
Second Line	:
City	:	PLANT CITY
State	:	FL
Zip	:	33567-3408
Country	:	US
Telephone Number	:	813-650-8600
Fax Number	:	813-650-8664

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	05/28/2024

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