Provider Demographics
NPI:1861504052
Name:TATUM, DEBRA A (MD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:A
Last Name:TATUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 N FRANK LLOYD WRIGHT BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-2691
Mailing Address - Country:US
Mailing Address - Phone:480-860-5533
Mailing Address - Fax:480-860-5005
Practice Address - Street 1:10715 N FRANK LLOYD WRIGHT BLVD STE 107
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-2691
Practice Address - Country:US
Practice Address - Phone:480-860-5533
Practice Address - Fax:480-860-5005
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34248208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ963662Medicaid
I41745Medicare UPIN
AZ963662Medicaid