Healthcare Provider Details

I. General information

NPI: 1679631220
Provider Name (Legal Business Name): J SHERMAN TATE MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 SOUTH RANCHO DRIVE SUITE E-32
LAS VEGAS NV
89106-4833
US

IV. Provider business mailing address

PO BOX 270700
LAS VEGAS NV
89127-4700
US

V. Phone/Fax

Practice location:
  • Phone: 701-388-4292
  • Fax: 702-388-2922
Mailing address:
  • Phone: 702-388-4292
  • Fax: 702-388-2922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES SHERMAN TATE JR.
Title or Position: CEO
Credential: MD
Phone: 702-388-4292