Basic Information
| Provider Information | |||||||||
| NPI: | 1154493591 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAFFER | ||||||||
| FirstName: | SAMUEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | AP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 627 SE 4TH AVE | ||||||||
| Address2: | APT 303 | ||||||||
| City: | FT LAUDERDALE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333013144 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545238840 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2337 S UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | DAVIE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333245842 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544239234 | ||||||||
| FaxNumber: | 9544239231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/14/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | AP1934 | FL | Y | Other Service Providers | Acupuncturist |
ID Information
| ID | Type | State | Issuer | Description | AP1934 | 01 | FL | FL LIC NUMBER | OTHER |