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General NPI Number Information
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NPI Number | 1871221150
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Entity Type | Individual
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Provider Name | DAMIAN LATHAM
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Gender | Male
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Dates
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Enumeration Date | 08/12/2022
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Last Update Date | 08/12/2022
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Provider Practice Location Address
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Address Line | 4045 W 15TH ST
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City | PLANO
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State | TX
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Zip | 75093-5891
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Country | US
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Telephone | 972-479-5923
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Fax |
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Provider Business Mailing Address
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Address Line | 3112 FALKLAND RD
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City | CARROLLTON
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State | TX
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Zip | 75007-3513
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Country | US
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Telephone | 618-367-3455
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 2157440
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License Number State | TX
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