Provider Demographics
NPI:1255508826
Name:LATHAM, WHITNEY LYNNE (DO)
Entity Type:Individual
Prefix:DR
First Name:WHITNEY
Middle Name:LYNNE
Last Name:LATHAM
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:717 S HOUSTON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74127-9023
Mailing Address - Country:US
Mailing Address - Phone:918-382-4600
Mailing Address - Fax:918-382-3183
Practice Address - Street 1:717 S HOUSTON AVE FL 4
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74127-9023
Practice Address - Country:US
Practice Address - Phone:918-382-4600
Practice Address - Fax:918-382-3183
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2019-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS014507208000000X
ME2287208000000X
NH17012208000000X
OK4424208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200209110AMedicaid