Healthcare Provider Details

I. General information

NPI: 1891793196
Provider Name (Legal Business Name): JEFFREY F LATHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2005
Last Update Date: 12/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 CUMBERLAND ST SUTIE 103
WOONSOCKET RI
02895-3323
US

IV. Provider business mailing address

68 CUMBERLAND ST SUTIE 103
WOONSOCKET RI
02895-3323
US

V. Phone/Fax

Practice location:
  • Phone: 401-762-3838
  • Fax: 401-762-8252
Mailing address:
  • Phone: 401-762-3838
  • Fax: 401-762-8252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD05050
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: