Healthcare Provider Details

I. General information

NPI: 1801360243
Provider Name (Legal Business Name): PETER TATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2019
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 NICHOLASVILLE RD STE 601
LEXINGTON KY
40503-1474
US

IV. Provider business mailing address

1760 NICHOLASVILLE RD STE 601
LEXINGTON KY
40503-1474
US

V. Phone/Fax

Practice location:
  • Phone: 859-785-5141
  • Fax: 859-221-8176
Mailing address:
  • Phone: 859-785-5141
  • Fax: 859-221-8176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER TATE
Title or Position: OWNER
Credential: MD
Phone: 859-785-5141