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General NPI Number Information
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NPI Number | 1851524540
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Entity Type | Organization
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Legal Business Name | FRED W LAFFERTY MD, INC
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Dates
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Enumeration Date | 08/27/2009
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Last Update Date | 11/03/2009
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Provider Practice Location Address
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Address Line | 1611 S GREEN RD SUITE 147
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-4128
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Country | US
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Telephone | 216-381-1142
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Fax | 216-381-6459
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Provider Business Mailing Address
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Address Line | 1611 S GREEN RD SUITE 147
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City | SOUTH EUCLID
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State | OH
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Zip | 44121-4128
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Country | US
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Telephone | 216-381-1142
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Fax | 216-381-6459
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERIC W LAFFERTY
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Credential | M.D.
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Telephone | 216-381-1142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 23458
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License Number State | OH
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