MEDICARE: DR. JOHN M. TATUM M.D.

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	2084P0800X	Psychiatry Physician	ME0030885	FL

General Provider Information

NPI Number	:	1639194145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN M. TATUM M.D.

Provider Business Mailing Address
First Line	:	2180 N PARK AVE
Second Line	:	SUITE 326
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-644-3593
Fax Number	:	407-644-1713

Provider Business Practice Location Address
First Line	:	2180 N PARK AVE
Second Line	:	SUITE 326
City	:	WINTER PARK
State	:	FL
Zip	:	32789-2359
Country	:	US
Telephone Number	:	407-644-3593
Fax Number	:	407-644-1713

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

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	05/17/2017

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