MEDICARE: DR. DEBRA K. LATTA, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36002939	OH

General Provider Information

NPI Number	:	1386964120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. DEBRA K. LATTA, LLC

Provider Business Mailing Address
First Line	:	1799 W 5TH AVE
Second Line	:	SUITE 103
City	:	COLUMBUS
State	:	OH
Zip	:	43212-2322
Country	:	US
Telephone Number	:	614-893-8437
Fax Number	:

Provider Business Practice Location Address
First Line	:	960 S BRINKER AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1724
Country	:	US
Telephone Number	:	614-668-8542
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. DEBRA K. LATTA
Credential	:	DPM
Telephone Number	:	614-893-8437

Provider Enumeration Date	:	06/03/2010
Last Update Date	:	06/03/2010

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