Provider Demographics
NPI:1710097126
Name:LAFFERTY, JULIE E (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:E
Last Name:LAFFERTY
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11477 OLDE CABIN RD STE 200
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7137
Mailing Address - Country:US
Mailing Address - Phone:314-567-5000
Mailing Address - Fax:314-567-3110
Practice Address - Street 1:12277 DE PAUL DR
Practice Address - Street 2:SUITE 303 SOUTH
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2516
Practice Address - Country:US
Practice Address - Phone:314-344-7575
Practice Address - Fax:314-344-7571
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO1084022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1533327OtherUNITED HEALTHCARE
MO120928OtherBLUE CROSS BLUE SHIELD
MO260040209OtherRR MEDICARE
MOG88410Medicare UPIN
MO000094291Medicare ID - Type Unspecified