Healthcare Provider Details

I. General information

NPI: 1720300882
Provider Name (Legal Business Name): JAMES T PATE MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2010
Last Update Date: 02/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4124 JACKSON STREET EXT
ALEXANDRIA LA
71303-2752
US

IV. Provider business mailing address

4124 JACKSON STREET EXT
ALEXANDRIA LA
71303-2752
US

V. Phone/Fax

Practice location:
  • Phone: 318-445-3653
  • Fax: 318-445-3678
Mailing address:
  • Phone: 318-445-3653
  • Fax: 318-445-3678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD.008637
License Number StateLA

VIII. Authorized Official

Name: JAMES T PATE
Title or Position: PRESIDENT
Credential: MD
Phone: 318-445-3653