Provider Demographics
NPI:1437188679
Name:LATTIMORE, WAYMON C (MD)
Entity Type:Individual
Prefix:
First Name:WAYMON
Middle Name:C
Last Name:LATTIMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 S WADSWORTH BLVD UNIT D100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5117
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-1120
Practice Address - Street 1:7000 W COLFAX AVE STE B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80214-5434
Practice Address - Country:US
Practice Address - Phone:303-573-9951
Practice Address - Fax:303-573-1013
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43304207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82332886Medicaid
COP00253292OtherRAILROAD MEDICARE
COC802226Medicare ID - Type Unspecified
COP00253292OtherRAILROAD MEDICARE