Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 00840 | CO |
NPI | 1659312767 |
---|---|
Provider Name | Mr. James E. Latta |
First Address | Highlands Ranch, CO 80129-2360 |
Second Address | Highlands Ranch, CO 80129-2360 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
698152 | UNITED CONCORDIA (01) | CO |
U29525 | (02) | CO |