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
State | License ID | Taxonomies |
---|---|---|
KS | 04-17606 | 207L00000X |
AR | C4950 | 207L00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207L00000X | Allopathic & Osteopathic Physicians | Anesthesiology |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AR | 5N421 | Other | BCBS |
P00292703 | Other | RR MEDICARE GROUP CK6327 | |
AR | 5N421C752 | Medicare PIN | |
KS | 15946LA | Medicare ID - Type Unspecified | |
P00292703 | Other | RR MEDICARE GROUP CK6327 | |
AR | 5N421 | Medicare PIN |