Healthcare Provider Details

I. General information

NPI: 1841261336
Provider Name (Legal Business Name): GREGORY SYDNOR LAFFITTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2006
Last Update Date: 02/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MICCOSUKEE RD HOSPITALISTS GROUP
TALLAHASSEE FL
32308-5054
US

IV. Provider business mailing address

2633 CENTENNIAL DRIVE SUITE 100
TALLAHASSEE FL
32308-0585
US

V. Phone/Fax

Practice location:
  • Phone: 850-431-4556
  • Fax: 850-431-6315
Mailing address:
  • Phone: 850-431-5404
  • Fax: 850-431-4794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number004152
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104253
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: