Provider Demographics
NPI:1871607176
Name:TATUM, JAMES LUTHER (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LUTHER
Last Name:TATUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2320 CASTLEFORD TERRACE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-6468
Mailing Address - Country:US
Mailing Address - Phone:804-379-3355
Mailing Address - Fax:
Practice Address - Street 1:1201 BROADROCK ROAD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23249
Practice Address - Country:US
Practice Address - Phone:804-675-5115
Practice Address - Fax:804-675-5506
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029773207U00000X, 2085R0202X
MDD45557207U00000X, 2085R0202X
NC7008207U00000X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E09190Medicare UPIN