Provider Demographics
NPI:1184010605
Name:TATE, ELIZA (MD)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:
Last Name:TATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17695 HIGHWAY 190
Mailing Address - Street 2:
Mailing Address - City:PORT BARRE
Mailing Address - State:LA
Mailing Address - Zip Code:70577-5178
Mailing Address - Country:US
Mailing Address - Phone:337-308-0802
Mailing Address - Fax:
Practice Address - Street 1:17695 HIGHWAY 190
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577
Practice Address - Country:US
Practice Address - Phone:337-585-7989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-10
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA310597207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine