Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | A117856 | CA |
Y | 208600000X | Surgeon | A117856 | CA |
N | 2086S0102X | Surgical Critical Care | A117856 | CA |
NPI | 1114204666 |
---|---|
Provider Name | James Michael Tatum |
First Address | Long Beach, CA 90813-3423 |
Second Address | Long Beach, CA 90813 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2011 |
Last Update Date | 14/08/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A117856 | STATE LICENSE NUMBER (01) | CA |