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General NPI Number Information
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NPI Number | 1396266516
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Entity Type | Individual
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Provider Name | EVAN THOMAS LATOURRETTE DPM
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Gender | Male
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 382 ROSEVALE AVE
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City | RONKONKOMA
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State | NY
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Zip | 11779-3069
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Country | US
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Telephone | 631-667-0388
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Fax | 631-968-7705
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Provider Business Mailing Address
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Address Line | 1231 DEER PARK AVE
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City | NORTH BABYLON
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State | NY
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Zip | 11703-3104
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Country | US
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Telephone | 631-667-0388
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Fax | 631-968-7705
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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 | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N007080-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | N007080
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N007080-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 213ES0131X
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Taxonomy Name | Foot Surgery Podiatrist
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License Number | N007080-1
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License Number State | NY
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Taxonomy #5
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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 #6
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Taxonomy Code | 213EP1101X
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Taxonomy Name | Primary Podiatric Medicine Podiatrist
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License Number | N007080-1
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License Number State | NY
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