MEDICARE: JAMES T PATE MD A MEDICAL CORPORATION

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	207Y00000X	Otolaryngology Physician	MD.008637	LA

General Provider Information

NPI Number	:	1720300882
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES T PATE MD A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	4124 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-445-3653
Fax Number	:	318-445-3678

Provider Business Practice Location Address
First Line	:	4124 JACKSON STREET EXT
Second Line	:
City	:	ALEXANDRIA
State	:	LA
Zip	:	71303-2752
Country	:	US
Telephone Number	:	318-445-3653
Fax Number	:	318-445-3678

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JAMES T PATE
Credential	:	MD
Telephone Number	:	318-445-3653

Provider Enumeration Date	:	02/17/2010
Last Update Date	:	02/17/2010

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