Individual
MS. DEBORAH B LATHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN,CRNA
Contact information
Practice address
6606 LBJ FWY STE 200, DALLAS, TX 75240-6524
(972) 715-5000
(972) 715-9976
Mailing address
PO BOX 840853, DALLAS, TX 75284-0865
(972) 715-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP106901
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1098469-05
—
TX
05
—
109846910
—
TX
01
—
109846912
MEDICAID CSHCN
TX
05
—
109846913
—
TX
05
—
315278703
—
TX
01
—
8335UG
BCBS TX
TX
01
—
8729UH
BCBS TX
TX
01
—
88805U
BCBSTX
TX
01
—
89626U
BCBS
TX
01
—
P008710407
RAILROAD
TX
Enumeration date
07/25/2006
Last updated
06/30/2020
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