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General NPI Number Information
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NPI Number | 1821079559
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Entity Type | Individual
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Provider Name | PAUL E TATUM III MD
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Gender | Male
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Dates
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Enumeration Date | 11/09/2005
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Last Update Date | 04/02/2025
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 314-652-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 4107 SPICEWOOD SPRINGS RD STE 100
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City | AUSTIN
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State | TX
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Zip | 78759-8645
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Country | US
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Telephone | 512-397-3360
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Fax | 512-343-7107
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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 | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 2022022258
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | R9296
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207QH0002X
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Taxonomy Name | Hospice and Palliative Medicine (Family Medicine) Physician
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License Number | 036160360
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License Number State | IL
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