Healthcare Provider Details

I. General information

NPI: 1801880927
Provider Name (Legal Business Name): JAMES LYLE LATIMER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/02/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16 CHURCH ST
MADRID NY
13660-0189
US

IV. Provider business mailing address

16 CHURCH ST PO BOX 189
MADRID NY
13660-0189
US

V. Phone/Fax

Practice location:
  • Phone: 315-322-8947
  • Fax: 315-327-4048
Mailing address:
  • Phone: 315-327-8947
  • Fax: 315-322-4048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number150723
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: