MEDICARE: LARRY D TATUM MD

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	207VG0400X	Gynecology Physician	F4585	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	160059746	OTHER	RAILROAD

General Provider Information

NPI Number	:	1437195609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LARRY D TATUM MD

Provider Business Mailing Address
First Line	:	PO BOX 961205
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76161-1205
Country	:	US
Telephone Number	:	817-740-8400
Fax Number	:	817-921-2701

Provider Business Practice Location Address
First Line	:	1250 8TH AVE STE 430
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4144
Country	:	US
Telephone Number	:	817-923-5558
Fax Number	:	817-923-0087

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	02/28/2020

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Directions to “ LARRY D TATUM MD” Practice Location

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