Provider Demographics
NPI:1326030602
Name:LATHROP, JAMES C (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:C
Last Name:LATHROP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1255 E COLLEGE ST STE 500
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4562
Mailing Address - Country:US
Mailing Address - Phone:931-363-8055
Mailing Address - Fax:931-363-8056
Practice Address - Street 1:1255 E COLLEGE ST STE 500
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4562
Practice Address - Country:US
Practice Address - Phone:931-363-8055
Practice Address - Fax:931-363-8056
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIJL044836208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4870025Medicaid
MI044836OtherBLUE CROSS
B46030Medicare UPIN
MI4870025Medicaid