Healthcare Provider Details

I. General information

NPI: 1750724944
Provider Name (Legal Business Name): JAMIE CHRISTOPHER LATOS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 04/08/2022
Certification Date: 04/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 SUNCREST TOWN CENTRE DR
MORGANTOWN WV
26505-0589
US

IV. Provider business mailing address

1370 JOHNSON AVE STE 102
BRIDGEPORT WV
26330-1492
US

V. Phone/Fax

Practice location:
  • Phone: 304-598-4478
  • Fax:
Mailing address:
  • Phone: 681-342-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2955
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: