Provider Demographics
NPI:1457327959
Name:LATON, GREGORY VINCENT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:VINCENT
Last Name:LATON
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:190 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-7439
Mailing Address - Country:US
Mailing Address - Phone:910-245-7534
Mailing Address - Fax:
Practice Address - Street 1:2817 REILLY RD
Practice Address - Street 2:WOMACK ARMY MEDICAL CENTER
Practice Address - City:FORT BRAGG
Practice Address - State:NC
Practice Address - Zip Code:28310-7324
Practice Address - Country:US
Practice Address - Phone:910-907-8922
Practice Address - Fax:910-907-6069
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC101083363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant