Provider Demographics
NPI:1225005853
Name:LATTER, STEPHEN EDWARD (DPM)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:EDWARD
Last Name:LATTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 VILLAGE LOOP RD
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-2793
Mailing Address - Country:US
Mailing Address - Phone:406-755-5250
Mailing Address - Fax:406-755-5251
Practice Address - Street 1:58 VILLAGE LOOP RD
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-2793
Practice Address - Country:US
Practice Address - Phone:406-755-5250
Practice Address - Fax:406-755-5251
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-02
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3877213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ06288ZOtherBS
CAE3877Medicaid
ZZZ06288ZOtherBS
CAE3877Medicaid