Provider Demographics
NPI:1861400533
Name:LATTING, CLIFTON A (MD)
Entity type:Individual
Prefix:
First Name:CLIFTON
Middle Name:A
Last Name:LATTING
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 1:1517 19TH STREET ENSLEY
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35218-2049
Mailing Address - Country:US
Mailing Address - Phone:205-785-0055
Mailing Address - Fax:205-780-5223
Practice Address - Street 1:1517 19TH STREET ENSLEY
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35218-2049
Practice Address - Country:US
Practice Address - Phone:205-785-0055
Practice Address - Fax:205-780-5223
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL8248207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000000766Medicaid
AL051000766OtherBCBS #
AL110030732OtherRAILROAD MEDICARE
AL051000766OtherBCBS #
C71713Medicare UPIN