Provider Demographics
NPI:1144268905
Name:LATHAM, PAIGE (MD)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:
Last Name:LATHAM
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:PO BOX 650865
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9534207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103996806Medicaid
TX103996805Medicaid
TX8X1972OtherBCBS
TXP00648348OtherRAILROAD
TX103996808Medicaid
TX8EH524OtherBCBS TX
TX103996804Medicaid
TX103996807Medicaid
TX103996806Medicaid
TXTXB114772Medicare PIN
TX103996805Medicaid
TX103996804Medicaid
TXP00648348OtherRAILROAD
TX103996807Medicaid