Provider Demographics
NPI:1285800151
Name:ARCHIBOLD, LATHA (MD)
Entity type:Individual
Prefix:DR
First Name:LATHA
Middle Name:
Last Name:ARCHIBOLD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:22001 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-7003
Mailing Address - Country:US
Mailing Address - Phone:832-595-7700
Mailing Address - Fax:832-595-7720
Practice Address - Street 1:22001 SOUTHWEST FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77469-7003
Practice Address - Country:US
Practice Address - Phone:832-595-7700
Practice Address - Fax:832-595-7720
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-01
Last Update Date:2011-03-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM9809207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8L0023Medicare PIN