Provider Demographics
NPI:1780871988
Name:LATORTUE, JEAN WOEL (MD)
Entity type:Individual
Prefix:
First Name:JEAN WOEL
Middle Name:
Last Name:LATORTUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 HWY 37 S
Mailing Address - Street 2:
Mailing Address - City:MT VERNON
Mailing Address - State:TX
Mailing Address - Zip Code:75457-6550
Mailing Address - Country:US
Mailing Address - Phone:903-537-8222
Mailing Address - Fax:903-537-8223
Practice Address - Street 1:506 HWY 37 S
Practice Address - Street 2:
Practice Address - City:MT VERNON
Practice Address - State:TX
Practice Address - Zip Code:75457-6550
Practice Address - Country:US
Practice Address - Phone:903-537-8222
Practice Address - Fax:903-537-8223
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-02
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191595103Medicaid
TX8L1588Medicare PIN