Provider Demographics
NPI:1568461960
Name:PATE, DONALD WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DONALD
Middle Name:WAYNE
Last Name:PATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1205 MCLAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:AR
Mailing Address - Zip Code:72112-3533
Mailing Address - Country:US
Mailing Address - Phone:870-523-0190
Mailing Address - Fax:870-523-0188
Practice Address - Street 1:1117 MCLAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:AR
Practice Address - Zip Code:72112-3551
Practice Address - Country:US
Practice Address - Phone:870-523-0217
Practice Address - Fax:870-523-8769
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2012-05-09
Deactivation Date:2006-03-18
Deactivation Code:
Reactivation Date:2006-03-27
Provider Licenses
StateLicense IDTaxonomies
TNTN0000027701208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3036765Medicaid
TN3036765Medicaid
TN3099498Medicare ID - Type Unspecified