Provider Demographics
NPI:1356549901
Name:TATE, JEFFERY D (PA-C)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:D
Last Name:TATE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:759 HIGHWAY 62 E
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:AR
Mailing Address - Zip Code:72653-3260
Mailing Address - Country:US
Mailing Address - Phone:870-594-8387
Mailing Address - Fax:870-701-5045
Practice Address - Street 1:555 W 6TH ST
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:AR
Practice Address - Zip Code:72653-3409
Practice Address - Country:US
Practice Address - Phone:870-425-8288
Practice Address - Fax:870-425-8299
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARPA-354OtherSTATE MEDICAL BOARD - P.A. LICENSE