Provider Demographics
NPI:1124069059
Name:VAD, LATA B (MD)
Entity type:Individual
Prefix:DR
First Name:LATA
Middle Name:B
Last Name:VAD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3801 NW 63RD ST
Mailing Address - Street 2:SUITE 160
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1921
Mailing Address - Country:US
Mailing Address - Phone:405-858-0600
Mailing Address - Fax:405-858-0602
Practice Address - Street 1:2129 SW 59TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73119-7024
Practice Address - Country:US
Practice Address - Phone:405-685-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK135022084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100019370AMedicaid
OK100019370AMedicaid