Healthcare Provider Details

I. General information

NPI: 1326139304
Provider Name (Legal Business Name): JOSHUA LUKE LATHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG UNIT 5210
APO AE
09461
US

IV. Provider business mailing address

PSC 41 BOX 2407
APO AE
09464
US

V. Phone/Fax

Practice location:
  • Phone: 011441638528124
  • Fax:
Mailing address:
  • Phone: 011441638528368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberN/A
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: