MEDICARE: MR. ROBERT LEE PATE PA-C

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	363A00000X	Physician Assistant	102262	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	202616	OTHER		MEDCOST

General Provider Information

NPI Number	:	1750382891
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT LEE PATE PA-C

Provider Business Mailing Address
First Line	:	6387 RAMSEY STREET
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311
Country	:	US
Telephone Number	:	910-615-3878
Fax Number	:	910-321-6219

Provider Business Practice Location Address
First Line	:	6387 RAMSEY STREET
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28311
Country	:	US
Telephone Number	:	910-615-3878
Fax Number	:	910-321-6219

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	05/03/2013

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