Healthcare Provider Details

I. General information

NPI: 1932191541
Provider Name (Legal Business Name): THOMAS EDWARD LAFFERTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3304 SW 34TH CIR SUITE 103
OCALA FL
34474-3358
US

IV. Provider business mailing address

4881 NW 8TH AVE SUITE 2
GAINESVILLE FL
32605-4582
US

V. Phone/Fax

Practice location:
  • Phone: 352-291-0245
  • Fax: 352-291-0231
Mailing address:
  • Phone: 352-547-2373
  • Fax: 352-416-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME73535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: