Provider Demographics
NPI:1386846681
Name:LATO, MARC MURRAY (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:MURRAY
Last Name:LATO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:2114 E MARSHALL AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-3113
Mailing Address - Country:US
Mailing Address - Phone:602-957-6267
Mailing Address - Fax:602-957-6267
Practice Address - Street 1:1313 E OSBORN RD
Practice Address - Street 2:SUITE 150
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5678
Practice Address - Country:US
Practice Address - Phone:602-778-3325
Practice Address - Fax:602-778-3331
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ9412207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE39156Medicare UPIN