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General NPI Number Information
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NPI Number | 1578769543
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Entity Type | Organization
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Legal Business Name | WESLEY TATE MD PC
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Dates
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Enumeration Date | 06/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2255 S 88TH ST
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City | LOUISVILLE
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State | CO
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Zip | 80027-9716
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Country | US
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Telephone | 303-666-2095
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Fax | 303-666-1801
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Provider Business Mailing Address
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Address Line | 1127 ORANGE PLACE
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City | BOULDER
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State | CO
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Zip | 80027
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Country | US
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Telephone | 303-666-2095
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Fax | 303-666-1801
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Authorized Official
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Title or Position | PC
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Name | DR. WESLEY A TATE
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Credential | MD
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Telephone | 303-666-2095
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 44990
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License Number State | CO
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