Provider Demographics
NPI:1245058775
Name:LAPORTE, GEFFREY GAETAN (MD , PA)
Entity type:Individual
Prefix:
First Name:GEFFREY
Middle Name:GAETAN
Last Name:LAPORTE
Suffix:
Gender:M
Credentials:MD , PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 SEA PINES WAY
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:FL
Mailing Address - Zip Code:33462-4248
Mailing Address - Country:US
Mailing Address - Phone:602-312-0938
Mailing Address - Fax:
Practice Address - Street 1:3155 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-6917
Practice Address - Country:US
Practice Address - Phone:561-858-8817
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR1871-PA363AM0700X
AZ10345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical