Healthcare Provider Details

I. General information

NPI: 1508838681
Provider Name (Legal Business Name): LYDIA F. LATOUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 08/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

IV. Provider business mailing address

1135 OCEAN SPRINGS RD
OCEAN SPRINGS MS
39564-3421
US

V. Phone/Fax

Practice location:
  • Phone: 228-875-6695
  • Fax: 228-875-6696
Mailing address:
  • Phone: 228-875-6695
  • Fax: 228-875-6696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number15180
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code207RH0000X
TaxonomyHematology (Internal Medicine) Physician
License Number15180
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number15180
License Number StateMS
# 4
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number15180
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: