Provider Demographics
NPI:1437466562
Name:LATIMER, LONNIEJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:LONNIEJAY
Middle Name:
Last Name:LATIMER
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 1:1309 W FAIRMONT PKWY
Mailing Address - Street 2:SUITE X
Mailing Address - City:LA PORTE
Mailing Address - State:TX
Mailing Address - Zip Code:77571-6134
Mailing Address - Country:US
Mailing Address - Phone:281-470-0543
Mailing Address - Fax:281-842-7621
Practice Address - Street 1:1309 W FAIRMONT PKWY
Practice Address - Street 2:SUITE X
Practice Address - City:LA PORTE
Practice Address - State:TX
Practice Address - Zip Code:77571-6134
Practice Address - Country:US
Practice Address - Phone:281-470-0543
Practice Address - Fax:281-842-7621
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2013-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7448208D00000X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine