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Mr. Ricky Dwayne Latham, MD
Cardiovascular Disease Physician in Idaho Falls, Idaho
NPI 1477553139

Ricky Dwayne Latham is a Cardiovascular Disease Physician based in Coos Bay, ID and is specialized in Cardiovascular Disease. Ricky Dwayne Latham practices in Idaho Falls, ID and has the professional credentials of MD. The NPI Number for Ricky Dwayne Latham is 1477553139 and holds a License No. M6887 (Idaho).

The current practice location address for Ricky Dwayne Latham is 2001 Valenica Drive, Idaho Falls, ID and can be reached out via phone at 208-524-9400 and via fax at 208-524-9401.

Location: 2001 Valenica Drive, Idaho Falls, ID, 97420-2125
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Provider Profile Details
NPI Number
1477553139
Provider Name
Ricky Dwayne Latham
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2001 Valenica Drive, Idaho Falls, ID, 97420-2125
Phone Number
208-524-9400
Fax Number
208-524-9401
Provider Enumeration Date
07/26/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
111489100 01 MEDICAID WYOMING, MWY
000010005099 01 BLUE SHIELD OF ID, BS
060053550 01 RAILROAD MEDICARE, RRM
DZ692 01 BLUE CROSS OF ID SE, BC2
M6887 01 ID ID
000010005099 01 BLUE SHIELD OF ID S, BS2
000353200 01 EDS- MEDICAID, EDS
111489100 01 WY/EDS CONSULTEC, INC WYM
8318842 01 MEDICAID OF WA, MD-W
DZ692 01 BLUE CROSS OF IDAHO, BC
000353200 05 ID
500680039 05 OR
0031512 01 MONTANA MEDICAID, MEM
1134041 01 MEDICARE-CIGNA, MC
institution
Provider Business Practice Location Address Details
Address
2001 Valenica Drive
City
State
Zip
83404
Phone Number
208-524-9400
Fax Number
208-524-9401
person
Provider Business Mailing Address Details
Address
2001 Valenica Drive
City
State
Zip
83404
Phone Number
208-524-9400
Fax Number
208-524-9401
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Internal Medicine
Speciality
Cardiovascular Disease
Taxonomy
License No.
M6887 (Idaho)
Definition
An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms.
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