Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 92-93 | NM |
NPI | 1023069812 |
---|---|
Provider Name | Dr. Earl A Latimer III |
First Address | Roswell, NM 88201-5110 |
Second Address | Roswell, NM 88201-5110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 03/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07167 | (05) | NM |
E54780 | (02) | |
F54780 | (02) | NM |