Provider Demographics
NPI:1306957345
Name:TATUM, ROGER PERRY (MD)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:PERRY
Last Name:TATUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:1660 S COLUMBIAN WAY
Mailing Address - Street 2:S-112-GS
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98108-1532
Mailing Address - Country:US
Mailing Address - Phone:206-764-2141
Mailing Address - Fax:206-764-2529
Practice Address - Street 1:1660 S COLUMBIAN WAY
Practice Address - Street 2:S-112-GS
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98108-1532
Practice Address - Country:US
Practice Address - Phone:206-764-2141
Practice Address - Fax:206-764-2529
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00039673208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery