Individual
MR. EVAN THOMAS LATOURRETTE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
382 ROSEVALE AVE, RONKONKOMA, NY 11779-3069
(631) 667-0388
(631) 968-7705
Mailing address
1231 DEER PARK AVE, NORTH BABYLON, NY 11703-3104
(631) 667-0388
(631) 968-7705
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
N007080
NY
213E00000X
Podiatrist
N007080-1
NY
213EP1101X
Primary Podiatric Medicine Podiatrist
Primary
N007080-1
NY
213ES0103X
Foot & Ankle Surgery Podiatrist
N007080-1
NY
213ES0131X
Foot Surgery Podiatrist
N007080-1
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B1386739514
—
NY
05
—
ETINAD01
—
NY
Enumeration date
06/28/2017
Last updated
07/15/2022
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