Healthcare Provider Details

I. General information

NPI: 1508247560
Provider Name (Legal Business Name): CHRISTOPHER ALBERT LATOUR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 09/09/2021
Certification Date: 09/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N STATE ST DEPARTMENT OF MEDICINE
JACKSON MS
39216-4500
US

IV. Provider business mailing address

3715 PRYTANIA ST STE 400
NEW ORLEANS LA
70115-3768
US

V. Phone/Fax

Practice location:
  • Phone: 601-984-5601
  • Fax: 601-984-6601
Mailing address:
  • Phone: 601-984-5601
  • Fax: 601-984-6601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT-2977
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number25585
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number325831
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: