Healthcare Provider Details

I. General information

NPI: 1477888352
Provider Name (Legal Business Name): CHARLES LATIMORE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/09/2009
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8201 W BROWARD BLVD
PLANTATION FL
33324-2701
US

IV. Provider business mailing address

11840 SW 42ND PL UNIT 341
MIRAMAR FL
33025-8067
US

V. Phone/Fax

Practice location:
  • Phone: 954-473-6600
  • Fax:
Mailing address:
  • Phone: 305-318-3243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME161673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: