Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | N007080-1 | NY |
Y | 222Z00000X | Podiatrist | N007080-1 | NY |
N | 213EP1101X | Primary Podiatric Medicine | N007080-1 | NY |
N | 213ES0103X | Foot & Ankle Surgery | N007080-1 | NY |
N | 213ES0131X | Foot Surgery | N007080-1 | NY |
NPI | 1396266516 |
---|---|
Provider Name | Mr. Evan Thomas Latourrette |
First Address | Batavia, NY 14020-2132 |
Second Address | Batavia, NY 14020-2132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2017 |
Last Update Date | 03/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B1386739514 | (05) | NY |
ETINAD01 | (05) | NY |