Provider Demographics
NPI:1851442016
Name:LATSCHAR, PATTI D (PA)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:D
Last Name:LATSCHAR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PATTI
Other - Middle Name:D
Other - Last Name:BART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10601 S MAY AVE
Mailing Address - Street 2:STE 12
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-2500
Mailing Address - Country:US
Mailing Address - Phone:405-703-4676
Mailing Address - Fax:405-703-4677
Practice Address - Street 1:3212 SW 89TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7956
Practice Address - Country:US
Practice Address - Phone:405-378-3000
Practice Address - Fax:405-378-7477
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200104700AMedicaid
OK200104700AMedicaid
OKOKA100717Medicare PIN
OK242713101Medicare PIN