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General NPI Number Information
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NPI Number | 1144332727
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Entity Type | Organization
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Legal Business Name | WILEY J LATHAM MD AND BERNICE G LATHAM MD PARTNERS
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 10/01/2012
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Provider Practice Location Address
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Address Line | 505 WEST LEIGH ST SUITE 301
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City | RICHMOND
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State | VA
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Zip | 23220
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Country | US
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Telephone | 804-780-3008
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Fax | 804-780-3014
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Provider Business Mailing Address
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Address Line | PO BOX 15483
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City | RICHMOND
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State | VA
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Zip | 23227-0000
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Country | US
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Telephone | 804-780-3008
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Fax | 804-780-3014
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Authorized Official
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Title or Position | PARTNER
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Name | DR. WILEY JACOB LATHAM III
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Credential | MD
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Telephone | 804-780-3008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 0101023313
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0101023261
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License Number State | VA
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