Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 2008028217 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 2008028217 | MO |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 31966 | AZ |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | R9296 | TX |
NPI | 1821079559 |
---|---|
Provider Name | Paul E Tatum |
First Address | Austin, TX 78705-1006 |
Second Address | Austin, TX 78701-1918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2005 |
Last Update Date | 04/12/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807026 | (05) | AZ |
G92003 | (02) | AZ |