Healthcare Provider Details

I. General information

NPI: 1568581718
Provider Name (Legal Business Name): UMAR LATIF MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/06/2020
Certification Date: 10/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 US HIGHWAY 380 SUITE 600
CROSS ROADS TX
76227
US

IV. Provider business mailing address

5999 CUSTER RD # 110-355
FRISCO TX
75035-9302
US

V. Phone/Fax

Practice location:
  • Phone: 940-365-5711
  • Fax: 940-365-5722
Mailing address:
  • Phone: 940-365-5711
  • Fax: 940-365-5722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM1197
License Number StateTX

VIII. Authorized Official

Name: UMAR LATIF
Title or Position: CEO
Credential: MD
Phone: 940-365-5711