Provider Demographics
NPI:1396803615
Name:LATORTUE, ROSEMAY T (MD)
Entity type:Individual
Prefix:
First Name:ROSEMAY
Middle Name:T
Last Name:LATORTUE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8751 N 30TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-2213
Mailing Address - Country:US
Mailing Address - Phone:813-980-2422
Mailing Address - Fax:813-980-2204
Practice Address - Street 1:8751 N 30TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33604-2213
Practice Address - Country:US
Practice Address - Phone:813-980-2422
Practice Address - Fax:813-980-2204
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0050777207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1D048748100Medicaid
FL593159976OtherTIN
FL1D048748100Medicaid