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NPI Code Detail

MEDICARE: DAMIAN LATHAM

MEDICARE: DAMIAN LATHAM
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
1208100000XPhysical Medicine & Rehabilitation Physician2157440TX

General Provider Information

NPI Number : 1871221150
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAMIAN LATHAM
Provider Business Mailing Address
First Line : 3112 FALKLAND RD
Second Line :
City : CARROLLTON
State : TX
Zip : 75007-3513
Country : US
Telephone Number : 618-367-3455
Fax Number :
Provider Business Practice Location Address
First Line : 4045 W 15TH ST
Second Line :
City : PLANO
State : TX
Zip : 75093-5891
Country : US
Telephone Number : 972-479-5923
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2022
Last Update Date : 08/12/2022

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Directions to “ DAMIAN LATHAM ” Practice Location

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