Provider Demographics
NPI:1699769729
Name:LATHEN, MARK C (DO)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:C
Last Name:LATHEN
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Gender:M
Credentials:DO
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Mailing Address - Street 1:3390 N CAMPBELL AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-2380
Mailing Address - Country:US
Mailing Address - Phone:520-795-7650
Mailing Address - Fax:520-325-1622
Practice Address - Street 1:3390 N CAMPBELL AVE
Practice Address - Street 2:STE 110
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719-2380
Practice Address - Country:US
Practice Address - Phone:520-795-7650
Practice Address - Fax:520-325-1622
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2007-08-14
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Provider Licenses
StateLicense IDTaxonomies
AZ2785207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZG04383Medicare UPIN
AZ63190Medicare ID - Type Unspecified