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1821091653

NPI Code Detail

MEDICARE: KEITH LAFFERTY MD

MEDICARE: KEITH LAFFERTY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	ME79508	FL
2	207P00000X	Emergency Medicine Physician	25MA07304700	NJ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2734337000	OTHER	NJ	AMERIHEALTH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	49485	OTHER	FL	BLUESHIELD

General Provider Information

NPI Number	:	1821091653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITH LAFFERTY MD

Provider Business Mailing Address
First Line	:	PO BOX 2147
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33902-2147
Country	:	US
Telephone Number	:	393-433-2922
Fax Number	:	239-343-3695

Provider Business Practice Location Address
First Line	:	13681 DOCTORS WAY
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33912-4300
Country	:	US
Telephone Number	:	239-343-3292
Fax Number	:	239-343-3695

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	06/15/2022

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Directions to “ KEITH LAFFERTY MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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