Provider Demographics
NPI:1477655462
Name:LATORRE, AGUSTIN J (MD)
Entity Type:Individual
Prefix:MR
First Name:AGUSTIN
Middle Name:J
Last Name:LATORRE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7000 SW 62ND AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-4716
Mailing Address - Country:US
Mailing Address - Phone:305-455-7451
Mailing Address - Fax:305-455-7435
Practice Address - Street 1:7000 SW 62ND AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-4716
Practice Address - Country:US
Practice Address - Phone:305-455-7451
Practice Address - Fax:305-445-7435
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2011-09-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FL34974207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL34974OtherMEDICAL LICENSE
D27933Medicare UPIN
FL95997Medicare PIN