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NPI Code Detail

MEDICARE: DR. LATA B VAD M.D.

MEDICARE: DR. LATA B VAD M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician13502OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124069059
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LATA B VAD M.D.
Provider Business Mailing Address
First Line : 3801 NW 63RD ST
Second Line : SUITE 160
City : OKLAHOMA CITY
State : OK
Zip : 73116-1921
Country : US
Telephone Number : 405-858-0600
Fax Number : 405-858-0602
Provider Business Practice Location Address
First Line : 2129 SW 59TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73119-7024
Country : US
Telephone Number : 405-685-6671
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/10/2006
Last Update Date : 09/05/2008

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