MEDICARE: DARRENTATEMD PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	L3851	TX

General Provider Information

NPI Number	:	1164819819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DARRENTATEMD PLLC

Provider Business Mailing Address
First Line	:	1327 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4735
Country	:	US
Telephone Number	:	817-334-7500
Fax Number	:	817-334-7501

Provider Business Practice Location Address
First Line	:	1327 HEMPHILL ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-4735
Country	:	US
Telephone Number	:	817-334-7500
Fax Number	:	817-334-7501

Authorized Official
Title or Position	:	OWNER
Name	:	DARREN RANDALL TATE
Credential	:	MD
Telephone Number	:	817-334-7500

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	04/21/2015

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