Provider Demographics
NPI:1639213366
Name:TUNSTALL-ROBINSON, LATANYA C (MD)
Entity Type:Individual
Prefix:DR
First Name:LATANYA
Middle Name:C
Last Name:TUNSTALL-ROBINSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:4579 LACLEDE AVE
Mailing Address - Street 2:343
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-2103
Mailing Address - Country:US
Mailing Address - Phone:314-361-0477
Mailing Address - Fax:314-361-3771
Practice Address - Street 1:5615 PERSHING AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-1757
Practice Address - Country:US
Practice Address - Phone:314-361-0477
Practice Address - Fax:314-361-3771
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2015-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO35725174400000X
IL036-058285207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction Medicine