Provider Demographics
NPI:1477888352
Name:LATIMORE, CHARLES
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:LATIMORE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11840 SW 42ND PL UNIT 341
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-8067
Mailing Address - Country:US
Mailing Address - Phone:305-318-3243
Mailing Address - Fax:
Practice Address - Street 1:8201 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-2701
Practice Address - Country:US
Practice Address - Phone:954-473-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-09
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME161673207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine