Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0200X | Radiology | A05536 | IA |
Y | 213ER0200X | Radiology | A05536 | IA |
NPI | 1700921459 |
---|---|
Provider Name | Dr. Robert C Tatum |
First Address | Davenport, IA 52806-3426 |
Second Address | Davenport, IA 52806-3426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2007 |
Last Update Date | 08/07/2007 |