Provider Demographics
NPI:1114204666
Name:TATUM, JAMES MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MICHAEL
Last Name:TATUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1045 ATLANTIC AVE STE 1004
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3423
Mailing Address - Country:US
Mailing Address - Phone:562-432-9911
Mailing Address - Fax:562-391-0180
Practice Address - Street 1:1045 ATLANTIC AVE STE 506
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3414
Practice Address - Country:US
Practice Address - Phone:562-432-9911
Practice Address - Fax:562-391-0180
Is Sole Proprietor?:No
Enumeration Date:2011-11-11
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA1178562086S0102X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA117856OtherSTATE LICENSE NUMBER