DR. SEAN DAVID LATTIMORE (NPI# 1710058961) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710058961 |
| Entity Type | Individual |
| Full Name | DR. SEAN DAVID LATTIMORE |
| Credential | D.O. |
| Practice Address |
1000 Eleven S Ste 4a Columbia IL 62236-1077 |
| Mailing Address |
Po Box 955534 Saint Louis MO 63195-5534 |
| Practice Telephone | 6182066120 |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-10-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036102258 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036102258 | 05 | |
| MEDICARE RR | P00429608 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 509 Hamacher St, Suite 103, Waterloo, IL 622981592 | 6189392273 | 6189390245 |
| Street Address |
1000 ELEVEN S STE 4A |
| City | COLUMBIA |
| State | IL |
| Zip Code | 62236-1077 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922179175 | Michael Nels Kirk | Family Medicine | 1000 Eleven S Ste 4a, Columbia, IL 62236-1077 | 2006-11-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962937300 | Assoicated Physicians Group Ltd | Nurse Practitioner | 1011 South, Suite 3b, Columbia, IL 62236 | 2017-04-24 |
| 1316284854 | Robert Siekerka | Pharmacist | 1412 N Evergreen Ln, Columbia, IL 62236 | 2013-01-03 |
| 1972874352 | Jennifer Harlin Wilhelm | Veterinarian | 1400 Columbia Center Drive, Bellson Animal Hospital, Columbia, IL 62236 | 2012-01-18 |
| 1912275314 | Synergy Therapeutics, PC | Dentist | 1000 Eleven South, Suite 3f, Columbia, IL 62236 | 2011-12-13 |
| 1134455991 | Julie Williams | Skilled Nursing Facility | 3 Eagle Crest Court, Columbia, IL 62236 | 2009-10-28 |
| 1831311158 | Lifetime Dental Care of Illinois, PC | Dentist | 240 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1730301268 | Affordable Dentistry Today, PC | Dentist | 242 Southwoods Centre Drive, Columbia, IL 62236 | 2007-05-03 |
| 1710109616 | Jason Clay King | Chiropractor | 117 West Cedar Street, Columbia, IL 62236 | 2007-05-02 |
| 1184704900 | Mitan Pediatric Therapy Inc | Occupational Therapist | 891 Meadowview Lane, Columbia, IL 62236 | 2006-10-16 |
| 1265528368 | Kathryn Ann Mager | Counselor | 9273 Coach Stop Road, Columbia, IL 62236 | 2006-10-05 |
| Find all providers in zip 62236 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447868005 | Brittany Mechelle Waterworth | Family Medicine | 3700 I 70 Dr Se Ste 106, Columbia, MO 65201-6587 | 2020-07-20 |
| 1730706839 | John James Gannon | Family Medicine | Prisma Health Medical Group Family Medicine, 3209 Colonial Drive, Columbia, SC 29203 | 2020-07-06 |
| 1053938852 | Garrison Glenn Rice | Family Medicine | Prisma Health Medical Group Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-29 |
| 1457977563 | Jenny Tatiana Gonzalez Guzman | Family Medicine | Prisma Health Family Medical Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-24 |
| 1942825500 | Jarvis Jamal Johnson | Family Medicine | Prisma Health Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-10 |
| 1386268183 | Nicolas Anthony Limogiannis | Family Medicine | Prisma Health Medical Group Family Medicine Center, 3209 Colonial Drive, Columbia, SC 29203 | 2020-06-08 |
| 1730724220 | Luci Lee Redman Cassella | Family Medicine | 8900 Columbia 100 Parway Suite G, Columbia, MD 21045 | 2019-11-08 |
| 1275177420 | Palmetto Primary Care Physicians | Family Medicine | 1415 Blanding St Ste 2, Columbia, SC 29201-2922 | 2019-10-31 |
| 1558919852 | Synergos Medical, LLC | Family Medicine | 1703 Oak Cliff Pl, Columbia, MO 65203-4719 | 2019-08-29 |
| 1972156982 | Maury Regional Medical Group, Inc | Family Medicine | 2478 Nashville Hwy Ste A, Columbia, TN 38401-0634 | 2019-07-18 |
| Find all providers in COLUMBIA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.