Provider Demographics
NPI:1821090416
Name:LATIMER, KATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:LATIMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 BRIARPATCH CT
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN PINE
Mailing Address - State:AR
Mailing Address - Zip Code:71956-9721
Mailing Address - Country:US
Mailing Address - Phone:501-767-9302
Mailing Address - Fax:
Practice Address - Street 1:1910 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7752
Practice Address - Country:US
Practice Address - Phone:501-321-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-17606207L00000X
ARC4950207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5N421OtherBCBS
P00292703OtherRR MEDICARE GROUP CK6327
AR5N421C752Medicare PIN
KS15946LAMedicare ID - Type Unspecified
P00292703OtherRR MEDICARE GROUP CK6327
AR5N421Medicare PIN