Mr. RICKY DWAYNE LATHAM MD
Individual Provider (NPI-1)
Active
Internal Medicine, Cardiovascular Disease
Provider Information
- NPI Number
1477553139- Provider Type
- Individual Provider (NPI-1)
- Credentials
- MD
- Status
- Active
Contact & Location
- Address
- 2001 VALENICA DRIVE SUITE 201, IDAHO FALLS, ID, 83404
- Phone
- (208) 524-9400
- Fax
- (208) 524-9401
Specialties & Taxonomies
Internal Medicine, Cardiovascular Disease
License: ID #M6887
Internal Medicine, Cardiovascular Disease
Primary License: OR #md170342