Healthcare Provider Details

I. General information

NPI: 1952413510
Provider Name (Legal Business Name): UMAR LATIF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
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 TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberM1197
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberM1197
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: