MEDICARE: DR. (HOWARD) KEITH LATHAM AP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AP896	FL

General Provider Information

NPI Number	:	1699984955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. (HOWARD) KEITH LATHAM AP

Provider Business Mailing Address
First Line	:	13969 152ND RD N
Second Line	:
City	:	JUPITER
State	:	FL
Zip	:	33478-3556
Country	:	US
Telephone Number	:	561-741-4446
Fax Number	:	561-691-1772

Provider Business Practice Location Address
First Line	:	5610 PGA BLVD
Second Line	:	SUITE 210
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-3838
Country	:	US
Telephone Number	:	561-741-4446
Fax Number	:	561-691-1772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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