Provider Demographics
NPI:1205838794
Name:TATE, RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:138 LAZARO BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-9126
Mailing Address - Country:US
Mailing Address - Phone:337-942-2065
Mailing Address - Fax:337-942-9964
Practice Address - Street 1:138 LAZARO BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-9126
Practice Address - Country:US
Practice Address - Phone:337-942-2065
Practice Address - Fax:337-942-9964
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA011879207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1139297Medicaid
LA1139297Medicaid
B60976Medicare UPIN