Individual
PRISCILLA W LATTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
400 HICKORY ST NW STE 101, ALBANY, OR 97321-1700
(541) 812-3360
(541) 812-4499
Mailing address
PO BOX 1188, CORVALLIS, OR 97339-1188
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
MD151051
OR
2083P0011X
Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
Primary
MD151051
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500623286
—
OR
Enumeration date
12/09/2005
Last updated
10/29/2020
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