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General NPI Number Information
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NPI Number | 1720300882
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Entity Type | Organization
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Legal Business Name | JAMES T PATE MD A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/17/2010
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 4124 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2752
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Country | US
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Telephone | 318-445-3653
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Fax | 318-445-3678
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Provider Business Mailing Address
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Address Line | 4124 JACKSON STREET EXT
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City | ALEXANDRIA
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State | LA
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Zip | 71303-2752
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Country | US
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Telephone | 318-445-3653
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Fax | 318-445-3678
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Authorized Official
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Title or Position | PRESIDENT
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Name | JAMES T PATE
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Credential | MD
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Telephone | 318-445-3653
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | MD.008637
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License Number State | LA
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