Healthcare Provider Details

I. General information

NPI: 1205263266
Provider Name (Legal Business Name): WILLIAM LEMASTER TATE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2013
Last Update Date: 03/06/2023
Certification Date: 03/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 AVENUE F NE
WINTER HAVEN FL
33881-4131
US

IV. Provider business mailing address

3745 NW MEDITERRANEAN LN
JENSEN BEACH FL
34957-3108
US

V. Phone/Fax

Practice location:
  • Phone: 632-931-1918
  • Fax:
Mailing address:
  • Phone: 772-335-9600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2969
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberUO 3474
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberOS13306
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number05-46627
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: