Provider Demographics
NPI:1962476002
Name:LATER, RICHARD WESLEY (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:WESLEY
Last Name:LATER
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 1:1055 N 300 W
Mailing Address - Street 2:#311
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3344
Mailing Address - Country:US
Mailing Address - Phone:801-357-7883
Mailing Address - Fax:801-357-7975
Practice Address - Street 1:1055 N 300 W
Practice Address - Street 2:#311
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3344
Practice Address - Country:US
Practice Address - Phone:801-357-7883
Practice Address - Fax:801-357-7975
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1678921205208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics