MEDICARE: MRS. JAMESETTA WARD TATE M.D.

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	207Q00000X	Family Medicine Physician	MD.015091	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306041454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JAMESETTA WARD TATE M.D.

Provider Business Mailing Address
First Line	:	PO BOX 29591
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71149-9591
Country	:	US
Telephone Number	:	318-603-0440
Fax Number	:

Provider Business Practice Location Address
First Line	:	6823 PINES RD
Second Line	:	A
City	:	SHREVEPORT
State	:	LA
Zip	:	71129-5205
Country	:	US
Telephone Number	:	318-603-0440
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	01/14/2010

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