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General NPI Number Information
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NPI Number | 1053842112
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Entity Type | Individual
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Provider Name | JOHAN LATORRE M.D., M.S
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Gender | Male
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Dates
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Enumeration Date | 03/21/2017
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Last Update Date | 06/30/2023
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Provider Practice Location Address
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Address Line | SRC 190 1717 6TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0001
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Country | US
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Telephone | 205-975-8298
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Fax |
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Provider Business Mailing Address
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Address Line | SRC 190 1717 6TH AVE S
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City | BIRMINGHAM
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State | AL
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Zip | 35294-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 44926
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 4351026956
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License Number State | MI
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