Provider Demographics
NPI:1932386646
Name:LATHAM, CHRISTIAN A (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:A
Last Name:LATHAM
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 1:1900 MALVERN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7759
Mailing Address - Country:US
Mailing Address - Phone:501-623-9300
Mailing Address - Fax:501-623-9305
Practice Address - Street 1:1900 MALVERN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7759
Practice Address - Country:US
Practice Address - Phone:501-623-9300
Practice Address - Fax:501-623-9305
Is Sole Proprietor?:No
Enumeration Date:2008-01-24
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5468208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR174882001Medicaid
AR5H285Medicare PIN