MEDICARE: HENRY LUCIUS LAFFITTE JR. 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	207Q00000X	Family Medicine Physician	15482	SC

General Provider Information

NPI Number	:	1912998204
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY LUCIUS LAFFITTE JR. MD

Provider Business Mailing Address
First Line	:	10 B KEMMERLIN LANE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-2702
Country	:	US
Telephone Number	:	843-322-8477
Fax Number	:	843-322-8077

Provider Business Practice Location Address
First Line	:	10B KEMMERLIN LANE
Second Line	:
City	:	BEAUFORT
State	:	SC
Zip	:	29907-2702
Country	:	US
Telephone Number	:	843-322-8477
Fax Number	:	843-322-8077

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	05/09/2013

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