Provider Demographics
NPI:1942475728
Name:TATE, DANIELLE LATRICE (MD)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:LATRICE
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 1:200 WAGNER PL APT 208
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-3628
Mailing Address - Country:US
Mailing Address - Phone:225-892-4534
Mailing Address - Fax:
Practice Address - Street 1:6215 HUMPHREYS BLVD STE 400
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2382
Practice Address - Country:US
Practice Address - Phone:901-227-9580
Practice Address - Fax:901-227-9527
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS25456207V00000X, 207VM0101X
TN50274207V00000X, 207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology