Provider Demographics
NPI:1053306241
Name:LAFFERTY, ROXANN G (PA-C)
Entity Type:Individual
Prefix:
First Name:ROXANN
Middle Name:G
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2550 N THUNDERBIRD CIR
Mailing Address - Street 2:STE 303
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85215-1214
Mailing Address - Country:US
Mailing Address - Phone:480-435-9132
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:450 S WILLARD ST
Practice Address - Street 2:STE. 120
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-6743
Practice Address - Country:US
Practice Address - Phone:928-634-2574
Practice Address - Fax:928-634-2841
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2017-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ2027363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ391201Medicaid
AZ391201Medicaid
AZZ103058Medicare PIN