Healthcare Provider Details

I. General information

NPI: 1265438600
Provider Name (Legal Business Name): MARION BUTLER PATE III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 01/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DENNIS DR
SANFORD NC
27330-6343
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8749
US

V. Phone/Fax

Practice location:
  • Phone: 919-774-4511
  • Fax: 919-774-3196
Mailing address:
  • Phone: 910-295-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number30448
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: