Provider Demographics
NPI:1841261336
Name:LAFFITTE, GREGORY SYDNOR (PA-C)
Entity type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:SYDNOR
Last Name:LAFFITTE
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:2633 CENTENNIAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-0585
Mailing Address - Country:US
Mailing Address - Phone:850-431-5404
Mailing Address - Fax:850-431-4794
Practice Address - Street 1:1300 MICCOSUKEE RD
Practice Address - Street 2:HOSPITALISTS GROUP
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5054
Practice Address - Country:US
Practice Address - Phone:850-431-4556
Practice Address - Fax:850-431-6315
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2017-02-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA004152363AM0700X
FLPA9104253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL291733500Medicaid
FL291733500Medicaid