Healthcare Provider Details

I. General information

NPI: 1306024039
Provider Name (Legal Business Name): STEVEN LATULIPPE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

531 SE CLAY ST
DALLAS OR
97338-2865
US

IV. Provider business mailing address

531 SE CLAY ST PO BOX 787
DALLAS OR
97338-2865
US

V. Phone/Fax

Practice location:
  • Phone: 503-623-5430
  • Fax: 503-831-1253
Mailing address:
  • Phone: 503-623-5430
  • Fax: 503-831-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberMD22341
License Number StateOR

VIII. Authorized Official

Name: DR. STEVEN LATULIPPE
Title or Position: PYSICAN
Credential: .M.D.
Phone: 503-623-5430