Individual
TIDO A LATOUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
Mailing address
1009 NOVUS DR STE 2, JOHNSON CITY, TN 37604-8237
(423) 283-0776
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
10345
TN
367500000X
Certified Registered Nurse Anesthetist
27158
SC
367500000X
Certified Registered Nurse Anesthetist
RN127822
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
205315
UNISON
TN
01
—
39792
TLC
TN
01
—
413868097
TRICARE
TN
01
—
4142848
BLUE CROSS
TN
01
—
P00391672
RR MEDICARE #
—
Enumeration date
10/03/2005
Last updated
03/17/2023
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