Provider Demographics
NPI:1427366038
Name:TATE, SIDNEY WAYNE (MD)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:WAYNE
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:SIDNEY
Other - Middle Name:WAYNE
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:9 MAGNOLIA CIR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-5705
Mailing Address - Country:US
Mailing Address - Phone:501-268-1802
Mailing Address - Fax:
Practice Address - Street 1:9 MAGNOLIA CIR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-5705
Practice Address - Country:US
Practice Address - Phone:501-268-1802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2059207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine