Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 0116023869 | VA |
NPI | 1073800710 |
---|---|
Provider Name | Dr. Moses Tucker Laffitte IV |
First Address | Norfolk, VA 23507-1219 |
Second Address | Norfolk, VA 23507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2011 |
Last Update Date | 01/07/2011 |