Provider Demographics
NPI:1962926980
Name:LATORTUE, PIERRE GARY
Entity type:Individual
Prefix:
First Name:PIERRE
Middle Name:GARY
Last Name:LATORTUE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CALLE DR BASORA N
Mailing Address - Street 2:
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4833
Mailing Address - Country:US
Mailing Address - Phone:787-834-0101
Mailing Address - Fax:
Practice Address - Street 1:15 CALLE DR BASORA N
Practice Address - Street 2:
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4833
Practice Address - Country:US
Practice Address - Phone:787-834-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-01
Last Update Date:2017-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19751207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine