Individual
MR. JOSEPH AMOS TATUM SR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
102 W 26TH ST, RIFLE, CO 81650-3109
(505) 592-2851
Mailing address
102 W 26TH ST, RIFLE, CO 81650-3109
(505) 592-2851
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
20218177072
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1993
.
CO
Enumeration date
01/17/2022
Last updated
01/17/2022
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