Provider Demographics
NPI:1629075726
Name:TATE, PETER S (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:TATE
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 1:1760 NICHOLASVILLE RD STE 601
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1474
Mailing Address - Country:US
Mailing Address - Phone:859-785-5141
Mailing Address - Fax:859-221-8176
Practice Address - Street 1:1760 NICHOLASVILLE RD STE 601
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1474
Practice Address - Country:US
Practice Address - Phone:859-785-5141
Practice Address - Fax:859-221-8176
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY270812086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY27081OtherSTATE MEDICAL LICENSE
KY27081OtherSTATE MEDICAL LICENSE
KYAT2562355OtherFEDERAL DEA
KY020039411Medicare PIN
KYAT2562355OtherFEDERAL DEA
KY64270812Medicaid