Individual
LAWRENCE G TATUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 DALLAS ST, SAN ANTONIO, TX 78205-1201
(210) 495-9860
Mailing address
PO BOX 12740, WESTMINSTER, CA 92685-2740
(562) 468-0227
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
H0873
TX
207R00000X
Internal Medicine Physician
H0873
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
110553801
—
TX
05
—
110553804
—
TX
01
—
8N2617
BCBS
TX
Enumeration date
09/08/2005
Last updated
02/17/2010
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