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General NPI Number Information
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NPI Number | 1043597404
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Entity Type | Individual
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Provider Name | MOLLY A TATUM D.O.
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Gender | Female
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Dates
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Enumeration Date | 11/12/2011
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Last Update Date | 11/09/2023
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Provider Practice Location Address
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Address Line | 3205 WOODMAN DR
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City | DAYTON
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State | OH
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Zip | 45420-1143
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Country | US
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Telephone | 937-298-4417
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Fax | 937-298-8260
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Provider Business Mailing Address
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Address Line | 6480 HARRISON AVE STE 201
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City | CINCINNATI
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State | OH
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Zip | 45247-7961
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Country | US
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Telephone | 513-713-1779
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Fax | 138-549-9215
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 34.012776
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License Number State | OH
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