Provider Demographics
NPI:1427368414
Name:D. GARY LATTIMER, M.D., INC
Entity Type:Organization
Organization Name:D. GARY LATTIMER, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:INA
Authorized Official - Middle Name:C
Authorized Official - Last Name:COSTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-537-5445
Mailing Address - Street 1:1329 LUSITANA ST
Mailing Address - Street 2:SUITE 708
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2429
Mailing Address - Country:US
Mailing Address - Phone:808-537-5445
Mailing Address - Fax:808-537-1813
Practice Address - Street 1:1329 LUSITANA ST
Practice Address - Street 2:SUITE 708
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2429
Practice Address - Country:US
Practice Address - Phone:808-537-5445
Practice Address - Fax:808-537-1813
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD7092208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty