Individual
WAYNE ARTHUR LATACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
301 FISHER ST, KEESLER AFB, BILOXI, MS 39534-2508
(228) 376-3372
(228) 376-0125
Mailing address
301 FISHER ST, KEESLER AFB, BILOXI, MS 39534-2508
(228) 376-3372
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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