MEDICARE: MR. RONALD G. TATE M.S. CCC-A

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	231H00000X	Audiologist	22445	OR
2	237700000X	Hearing Instrument Specialist		OR
3	237600000X	Audiologist-Hearing Aid Fitter		OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639125594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RONALD G. TATE M.S. CCC-A

Provider Business Mailing Address
First Line	:	8800 SE SUNNYSIDE RD STE 300N
Second Line	:
City	:	CLACKAMAS
State	:	OR
Zip	:	97015-5703
Country	:	US
Telephone Number	:	281-286-2999
Fax Number	:	512-607-4893

Provider Business Practice Location Address
First Line	:	401 CRATER LAKE AVE STE 1
Second Line	:
City	:	MEDFORD
State	:	OR
Zip	:	97504-6860
Country	:	US
Telephone Number	:	541-608-9600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	03/17/2018

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