Provider Demographics
NPI:1710946751
Name:LATHAM, WILLIAM HOWARD JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HOWARD
Last Name:LATHAM
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:910 KATHERINE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-3692
Mailing Address - Country:US
Mailing Address - Phone:419-281-7941
Mailing Address - Fax:419-289-1534
Practice Address - Street 1:910 KATHERINE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-3692
Practice Address - Country:US
Practice Address - Phone:419-281-7941
Practice Address - Fax:419-289-1534
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002437213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0906550001OtherMEDICARE NCS
OH0625774OtherPTAN
OH0742496Medicaid
OH480013191OtherRAILROAD MEDICARE #
OH480013191OtherRAILROAD MEDICARE #