Provider Demographics
NPI:1720300882
Name:JAMES T PATE MD A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:JAMES T PATE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:T
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-445-3653
Mailing Address - Street 1:4124 JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2752
Mailing Address - Country:US
Mailing Address - Phone:318-445-3653
Mailing Address - Fax:318-445-3678
Practice Address - Street 1:4124 JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2752
Practice Address - Country:US
Practice Address - Phone:318-445-3653
Practice Address - Fax:318-445-3678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.008637207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B65298Medicare UPIN