MEDICARE: DR. JAMES E TATE D.O.

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	207L00000X	Anesthesiology Physician	989	NV

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	:	1760474977
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES E TATE D.O.

Provider Business Mailing Address
First Line	:	129 W LAKE MEAD PKWY
Second Line	:	B 18
City	:	HENDERSON
State	:	NV
Zip	:	89015-7055
Country	:	US
Telephone Number	:	702-564-4440
Fax Number	:	702-558-1522

Provider Business Practice Location Address
First Line	:	129 W LAKE MEAD PKWY
Second Line	:	B 18
City	:	HENDERSON
State	:	NV
Zip	:	89015-7055
Country	:	US
Telephone Number	:	702-564-4440
Fax Number	:	702-558-1522

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	05/18/2012

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Directions to “ DR. JAMES E TATE D.O.” Practice Location

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