Healthcare Provider Details

I. General information

NPI: 1255508826
Provider Name (Legal Business Name): WHITNEY LYNNE LATHAM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2008
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1775 THOMPSON ROAD
COOS BAY OR
97420
US

IV. Provider business mailing address

1775 THOMPSON ROAD
COOS BAY OR
97420
US

V. Phone/Fax

Practice location:
  • Phone: 207-891-2600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number17012
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2287
License Number StateME
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOS014507
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4424
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: