Provider Demographics
NPI:1508969833
Name:LATIMER, CARLOS A (MD FACP FACG)
Entity Type:Individual
Prefix:DR
First Name:CARLOS
Middle Name:A
Last Name:LATIMER
Suffix:
Gender:M
Credentials:MD FACP FACG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EDIF CADILLA
Mailing Address - Street 2:100 PASEO SAN PABLO SUITE 210
Mailing Address - City:BAYAMON
Mailing Address - State:PR
Mailing Address - Zip Code:00961-7022
Mailing Address - Country:US
Mailing Address - Phone:787-780-6095
Mailing Address - Fax:
Practice Address - Street 1:EDIF CADILLA
Practice Address - Street 2:100 PASEO SAN PABLO SUITE 210
Practice Address - City:BAYAMON
Practice Address - State:PR
Practice Address - Zip Code:00961-7022
Practice Address - Country:US
Practice Address - Phone:787-780-6095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR5867207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR97844Medicare ID - Type Unspecified
PRD26667Medicare UPIN