Provider Demographics
NPI:1801880927
Name:LATIMER, JAMES LYLE (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LYLE
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 1:16 CHURCH ST
Mailing Address - Street 2:PO BOX 189
Mailing Address - City:MADRID
Mailing Address - State:NY
Mailing Address - Zip Code:13660-0189
Mailing Address - Country:US
Mailing Address - Phone:315-327-8947
Mailing Address - Fax:315-322-4048
Practice Address - Street 1:16 CHURCH ST
Practice Address - Street 2:
Practice Address - City:MADRID
Practice Address - State:NY
Practice Address - Zip Code:13660-0189
Practice Address - Country:US
Practice Address - Phone:315-322-8947
Practice Address - Fax:315-327-4048
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY150723207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
002628OtherBCBS
089001OtherMVP
NY00715086Medicaid
B82174Medicare UPIN
53185BMedicare ID - Type Unspecified