Doctor Name: | JUSTIN LATIMER |
NPI Number: | 1316295652 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PA |
License Number: | 0110003925 |
Business Practice Address: | 300 Mt Clement Park Suite B Tappahannock, VA - 225605098 |
Business Phone Number: | 8044438670 |
Business Fax Number: | 8044438675 |
Mailing Address: | 856 J Clyde Morris Blvd, Suite A NEWPORT NEWS |
State: | VA |
Postal Code: | 236011318 |
Phone Number: | 7575944006 |
Fax Number: | 7575345190 |
NPI Enumeration Date: | 08/16/2012 |
NPI Last Update Date: | 10/08/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AS0400X |
License Number: | 0110003925 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Surgical |
Taxonomy Definition: |