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General NPI Number Information
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NPI Number | 1679867394
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Entity Type | Individual
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Provider Name | RYAN H TATUM MD
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Gender | Male
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Dates
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Enumeration Date | 05/31/2011
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Last Update Date | 02/21/2024
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Provider Practice Location Address
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Address Line | 954 W VAN ALSTYNE PKWY
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City | VAN ALSTYNE
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State | TX
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Zip | 75495-3531
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Country | US
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Telephone | 903-416-3790
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Fax | 903-712-3790
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Provider Business Mailing Address
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Address Line | 4800 HEDGCOXE RD SUITE 200
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City | PLANO
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State | TX
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Zip | 75024-2403
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Country | US
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Telephone | 469-800-6120
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Fax | 469-800-6129
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P8197
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License Number State | TX
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