Provider Demographics
NPI:1073593919
Name:LATELLA, JOSEPH X (DO)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:X
Last Name:LATELLA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:914 WILLSON AVE
Mailing Address - Street 2:
Mailing Address - City:WEBSTER CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50595-2215
Mailing Address - Country:US
Mailing Address - Phone:515-832-2911
Mailing Address - Fax:515-832-1298
Practice Address - Street 1:914 WILLSON AVE
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2215
Practice Address - Country:US
Practice Address - Phone:515-832-2911
Practice Address - Fax:515-832-1298
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2010-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01432207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAA54861Medicare UPIN