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Individual
WAYNE ARTHUR LATACK
Active
Individual
WAYNE ARTHUR LATACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
21859
MS
208M00000X
Hospitalist Physician
21859
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21859
MEDICAL LICENSURE
MS
Enumeration date
05/23/2007
Last updated
10/12/2023
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