Healthcare Provider Details

I. General information

NPI: 1871974386
Provider Name (Legal Business Name): CHRISTOPHER ALAN LATZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 10/25/2024
Certification Date: 10/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

653 W 8TH ST FL 3
JACKSONVILLE FL
32209-6511
US

IV. Provider business mailing address

PO BOX 44008
JACKSONVILLE FL
32231-4008
US

V. Phone/Fax

Practice location:
  • Phone: 904-224-7418
  • Fax:
Mailing address:
  • Phone: 904-224-7418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberL-264060
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME157706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: