Healthcare Provider Details

I. General information

NPI: 1215936471
Provider Name (Legal Business Name): GREGORY A LATCHAW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 05/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12959 PALMS WEST DR SUITE 130
LOXAHATCHEE FL
33470-4937
US

IV. Provider business mailing address

12959 PALMS WEST DR SUITE 130
LOXAHATCHEE FL
33470-4937
US

V. Phone/Fax

Practice location:
  • Phone: 561-793-5657
  • Fax: 561-793-5608
Mailing address:
  • Phone: 561-793-5657
  • Fax: 561-793-5608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME93571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: