Provider Demographics
NPI:1801841325
Name:TATUM, ROBERT R (PA-C)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:R
Last Name:TATUM
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:501 E BROADWAY
Mailing Address - Street 2:#220
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1785
Mailing Address - Country:US
Mailing Address - Phone:502-589-4856
Mailing Address - Fax:502-589-5093
Practice Address - Street 1:530 SOUTH JACKSON STREET
Practice Address - Street 2:DHC
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-562-6500
Practice Address - Fax:502-562-6196
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYPA500363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant