Provider Demographics
NPI:1174559686
Name:JERATH TATUM, ASHLEY M (MD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:M
Last Name:JERATH TATUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:J
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:9725 3RD AVE NE STE 500
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-2024
Mailing Address - Country:US
Mailing Address - Phone:206-527-1200
Mailing Address - Fax:206-527-2514
Practice Address - Street 1:9725 3RD AVE NE STE 500
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-2024
Practice Address - Country:US
Practice Address - Phone:206-527-1200
Practice Address - Fax:206-527-2514
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00040523207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8290835Medicaid
WA030005331OtherRAIL ROAD MEDICARE
WA7981JEOtherREGENCE
WA8290835Medicaid
WAL78070Medicare UPIN