MEDICARE: MS. DORIS DIANE TATUM

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	104100000X	Social Worker	465467	AZ

General Provider Information

NPI Number	:	1497983316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DORIS DIANE TATUM

Provider Business Mailing Address
First Line	:	8933 W VERNON AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3628
Country	:	US
Telephone Number	:	623-247-1330
Fax Number	:

Provider Business Practice Location Address
First Line	:	8933 W VERNON AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85037-3628
Country	:	US
Telephone Number	:	623-247-1330
Fax Number	:

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

Provider Enumeration Date	:	06/30/2009
Last Update Date	:	06/30/2009

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