Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 57260 | CA |
Y | 1223S0112X | Oral and Maxillofacial Surgeon | DN1855054 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | 262350 | MA |
N | 204E00000X | Oral & Maxillofacial Surgeon | A126769 | CA |
NPI | 1053584771 |
---|---|
Provider Name | Dr. Nathan James Latimer |
First Address | Centerville, MA 02632-2505 |
Second Address | Hyannis, MA 02601-5434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2008 |
Last Update Date | 16/03/2016 |