Provider Demographics
NPI:1932191541
Name:LAFFERTY, THOMAS EDWARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWARD
Last Name:LAFFERTY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-547-2373
Mailing Address - Fax:352-416-1813
Practice Address - Street 1:3304 SW 34TH CIR
Practice Address - Street 2:SUITE 103
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-3358
Practice Address - Country:US
Practice Address - Phone:352-291-0245
Practice Address - Fax:352-291-0231
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2014-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73535174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007908900Medicaid
FL41431ZMedicare PIN
FL41431Medicare ID - Type Unspecified