Provider Demographics
NPI:1679867394
Name:TATUM, RYAN H (MD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:H
Last Name:TATUM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4800 HEDGCOXE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-2403
Mailing Address - Country:US
Mailing Address - Phone:469-800-6120
Mailing Address - Fax:469-800-6129
Practice Address - Street 1:954 W VAN ALSTYNE PKWY
Practice Address - Street 2:
Practice Address - City:VAN ALSTYNE
Practice Address - State:TX
Practice Address - Zip Code:75495-3531
Practice Address - Country:US
Practice Address - Phone:903-416-3790
Practice Address - Fax:903-712-3790
Is Sole Proprietor?:No
Enumeration Date:2011-05-31
Last Update Date:2024-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP8197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine