Provider Demographics
NPI:1992986368
Name:LATHAM, DAVID ALLEN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:LATHAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 NEWMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:75840-1419
Mailing Address - Country:US
Mailing Address - Phone:903-644-6652
Mailing Address - Fax:903-644-1604
Practice Address - Street 1:125 NEWMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:TX
Practice Address - Zip Code:75840-1419
Practice Address - Country:US
Practice Address - Phone:903-644-6652
Practice Address - Fax:903-644-1604
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2016-08-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM9440207Q00000X, 207P00000X
OK25781207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine