Provider Demographics
NPI:1528102670
Name:TATUM, JAMES KENT (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KENT
Last Name:TATUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1820 PRESTON PARK BLVD
Mailing Address - Street 2:STE 1825
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5215
Mailing Address - Country:US
Mailing Address - Phone:972-867-7862
Mailing Address - Fax:
Practice Address - Street 1:3901 W 15TH ST
Practice Address - Street 2:SUITE 2A
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7738
Practice Address - Country:US
Practice Address - Phone:972-596-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM21472085R0203X, 2085R0204X, 2085R0202X, 2085N0700X
OK282192085R0204X
CAA1045052085R0204X, 2085R0202X, 207T00000X, 2085D0003X, 2085N0700X
CODR.00687132085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No2085D0003XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Neuroimaging