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General NPI Number Information
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NPI Number | 1073511978
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Entity Type | Individual
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Provider Name | BOBBY R LAFFERTY DO
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Gender | Male
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 07/02/2009
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Provider Practice Location Address
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Address Line | 1302 RIVER ST
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City | PALATKA
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State | FL
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Zip | 32177-5042
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Country | US
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Telephone | 386-328-8371
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Fax | 386-312-0775
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Provider Business Mailing Address
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Address Line | 1302 RIVER ST
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City | PALATKA
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State | FL
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Zip | 32177-5042
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Country | US
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Telephone | 386-328-8371
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Fax | 386-328-8371
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 1716
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS9833
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License Number State | FL
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