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General NPI Number Information
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NPI Number | 1588733562
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Entity Type | Individual
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Provider Name | KERRY PATRICIA LATHAM MD
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Gender | Female
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 1611 NW 12TH AVE ET3019
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City | MIAMI
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State | FL
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Zip | 33136-1005
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Country | US
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Telephone | 305-585-5285
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Fax |
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Provider Business Mailing Address
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Address Line | 2101 BRICKELL AVE APT 403
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City | MIAMI
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State | FL
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Zip | 33129-2102
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Country | US
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Telephone | 210-385-3500
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 0101259723
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 0101259723
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | ME92290
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License Number State | FL
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