Dr RICKY DWAYNE LATHAM MD is a male medical professional, specializing in Cardiovascular Disease (cardiology). He graduated in 1979 from Louisiana State University School Of Medicine In Shreveport.
ST MARKS PROFESSIONAL SERVICES LLC
3100 CHANNING WAY
IDAHO FALLS
ID
834047533
Tel: 2085296111
| Npi | 1477553139 |
| Pac Id | 0446249387 |
| Professional Enrollment Id | I20040507000103 |
| Last Name | LATHAM |
| First Name | RICKY |
| Middle Name | DWAYNE |
| Suffix | |
| Gender | M |
| Credential | MD |
| Medical School Name | LOUISIANA STATE UNIVERSITY SCHOOL OF MEDICINE IN SHREVEPORT |
| Graduation Year | 1979 |
| Primary Specialty | CARDIOVASCULAR DISEASE (CARDIOLOGY) |
| Secondary Specialty 1 | INTERVENTIONAL CARDIOLOGY |
| Secondary Specialty 2 | |
| Secondary Specialty 3 | |
| Secondary Specialty 4 | |
| All Secondary Specialties | INTERVENTIONAL CARDIOLOGY |
| Organization Legal Name | ST MARKS PROFESSIONAL SERVICES LLC |
| Group Practice Pac Id | 1355248089 |
| Number Of Group Practice Members | 28 |
| Line 1 Street Address | 3100 CHANNING WAY |
| Line 2 Street Address | |
| Marker Of Address Line 2 Suppression | |
| City | IDAHO FALLS |
| State | ID |
| Zip Code | 834047533 |
| Phone Number | 2085296111 |
| Hospital Affiliation Ccn 1 | 130018 |
| Hospital Affiliation Lbn 1 | EASTERN IDAHO REGIONAL MEDICAL CENTER |
| Hospital Affiliation Ccn 2 | 131325 |
| Hospital Affiliation Lbn 2 | BINGHAM MEMORIAL HOSPITAL |
| Hospital Affiliation Ccn 3 | 130065 |
| Hospital Affiliation Lbn 3 | MOUNTAIN VIEW HOSPITAL |
| Hospital Affiliation Ccn 4 | 130025 |
| Hospital Affiliation Lbn 4 | MADISON MEMORIAL HOSPITAL |
| Hospital Affiliation Ccn 5 | |
| Hospital Affiliation Lbn 5 | |
| Professional Accepts Medicare Assignment | Y |
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