Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC006925 | PA |
NPI | 1013402205 |
---|---|
Provider Name | Dr. Shaun M Latshaw |
First Address | Philadelphia, PA 19118-2718 |
Second Address | Philadelphia, PA 19118-2718 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2018 |
Last Update Date | 29/06/2018 |