Healthcare Provider Details

I. General information

NPI: 1154493591
Provider Name (Legal Business Name): SAMUEL LAFFER AP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2337 S UNIVERSITY DR
DAVIE FL
33324-5842
US

IV. Provider business mailing address

627 SE 4TH AVE APT 303
FT LAUDERDALE FL
33301-3144
US

V. Phone/Fax

Practice location:
  • Phone: 954-423-9234
  • Fax: 954-423-9231
Mailing address:
  • Phone: 954-523-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP1934
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: