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Individual

PAUL E. LATER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662
Mailing address
7956 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 436-2416
(260) 436-9662

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
01040003A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0873890
OH
05
100319610
IN
01
130006860
RR MEDICARE
IN
05
3035350
MI
Enumeration date
06/30/2005
Last updated
12/28/2010
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