Individual
JONATHAN DAVID TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 PLAIN STREET 3RD FLOOR SUITE 101, PROVIDENCE, RI 02902-3026
(401) 444-5504
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
2080P0205X
Pediatric Endocrinology Physician
Primary
MD19694
RI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/21/2018
Last updated
08/06/2024
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