Latham, Ricky Dwayne

Latham, Ricky Dwayne is an individual health care provider with primary practice located at 2001 Valenica Drive Suite 201, Idaho Falls ID 83404. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Latham, Ricky Dwayne can be contacted via phone (208) 524-9400.

Contact Information

Primary practice address
2001 Valenica Drive Suite 201 Idaho Falls ID 83404
Phone: (208) 524-9400
Fax: (208) 524-9401
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X M6887 Idaho
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X MD170342 Oregon

Profile Details

NPI number 1477553139
LBN Legal business name Latham, Ricky Dwayne
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 26th, 2005
Last updated Feb 13th, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1477553139 NPPES
Other 111489100 MEDICAID WYOMING, MWY
Other 000010005099 MEDICAID WYOMING, MWY
Other 060053550 MEDICAID WYOMING, MWY
Other DZ692 MEDICAID WYOMING, MWY
Other M6887 MEDICAID WYOMING, MWY
Other 000010005099 MEDICAID WYOMING, MWY
Other 000353200 MEDICAID WYOMING, MWY
Other 111489100 MEDICAID WYOMING, MWY
Other 8318842 MEDICAID WYOMING, MWY
Other DZ692 MEDICAID WYOMING, MWY
MEDICAID 000353200 MEDICAID WYOMING, MWY
MEDICAID 500680039 MEDICAID WYOMING, MWY
Other 0031512 MEDICAID WYOMING, MWY
Other 1134041 MEDICAID WYOMING, MWY

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