Healthcare Provider Details

I. General information

NPI: 1427368414
Provider Name (Legal Business Name): D. GARY LATTIMER, M.D., INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2010
Last Update Date: 10/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1329 LUSITANA ST SUITE 708
HONOLULU HI
96813-2429
US

IV. Provider business mailing address

1329 LUSITANA ST SUITE 708
HONOLULU HI
96813-2429
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-5445
  • Fax: 808-537-1813
Mailing address:
  • Phone: 808-537-5445
  • Fax: 808-537-1813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberMD7092
License Number StateHI

VIII. Authorized Official

Name: MS. INA C COSTA
Title or Position: PRACTICE MANAGER
Credential:
Phone: 808-537-5445