Provider Demographics
NPI:1043484462
Name:NICE, TATE RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:TATE
Middle Name:RICHARD
Last Name:NICE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4499 MEDICAL DR STE 347
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3853
Mailing Address - Country:US
Mailing Address - Phone:210-615-8757
Mailing Address - Fax:210-615-8789
Practice Address - Street 1:4499 MEDICAL DR STE 347
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3853
Practice Address - Country:US
Practice Address - Phone:210-615-8757
Practice Address - Fax:210-615-8789
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL325212086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery