MEDICARE: PAUL E TATUM III 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	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	2022022258	MO
2	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	R9296	TX
3	207QH0002X	Hospice and Palliative Medicine (Family Medicine) Physician	036160360	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821079559
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL E TATUM III MD

Provider Business Mailing Address
First Line	:	4107 SPICEWOOD SPRINGS RD STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-8645
Country	:	US
Telephone Number	:	512-397-3360
Fax Number	:	512-343-7107

Provider Business Practice Location Address
First Line	:	915 N GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63106-1621
Country	:	US
Telephone Number	:	314-652-4100
Fax Number	:

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	04/02/2025

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