MEDICARE: JOHN M TATUM MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	ME0030885	FL

General Provider Information

NPI Number	:	1558582254
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN M TATUM MD PA

Provider Business Mailing Address
First Line	:	2180 N PARK AVE
Second Line	:	SUITE 326
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-644-3593
Fax Number	:	407-644-1713

Provider Business Practice Location Address
First Line	:	2180 N PARK AVE
Second Line	:	SUITE 326
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-644-3593
Fax Number	:	407-644-1713

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOHN M TATUM
Credential	:	M.D.
Telephone Number	:	407-644-3593

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	05/17/2017

Similar Medicare Providers

1639194145 — DR. JOHN M. TATUM M.D.
Practice Location Address:

2180 N PARK AVE , SUITE 326
WINTER PARK, FL
32789-2359

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1538248398 — DR. ROBERT B GOLDSTEIN MD
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1578786455 — MRS. LORI SELWYN SMITH LCSW
Practice Location Address:

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1841418456 — DR. JEFFREY LEE PRICKETT PSY.D., AP
Practice Location Address:

2180 N PARK AVE , #326
WINTER PARK, FL
32789-2359

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1134390230 — ANDREW MICHAEL KLEIMAN M.D.
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