Individual
CLIFTON TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
200 E GRAY ST, LOUISVILLE, KY 40202-2012
(502) 629-7601
Mailing address
234 E GRAY ST, SUITE 850, LOUISVILLE, KY 40202-1900
(502) 585-1735
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
26863
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000050041
BC BS
KY
01
—
000000308613
BC BS
KY
05
—
100356810A
—
IN
01
—
1052796
PASSPORT
KY
01
—
50005985
PASSPORT
KY
05
—
64268634
—
KY
Enumeration date
07/11/2005
Last updated
01/25/2013
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