Individual
BILL D TATUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
1201 HEALTH CENTER PKWY, YUKON, OK 73099-6381
(405) 717-6800
Mailing address
DEPT 963410, OKLAHOMA CITY, OK 73196-3410
(405) 717-6800
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0071233
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200020660A
—
OK
01
—
P00364317
RR MEDICARE
OK
Enumeration date
03/14/2006
Last updated
08/11/2011
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