Provider Demographics
NPI:1750382891
Name:PATE, ROBERT LEE (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:LEE
Last Name:PATE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6387 RAMSEY STREET
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28311
Mailing Address - Country:US
Mailing Address - Phone:910-615-3878
Mailing Address - Fax:910-321-6219
Practice Address - Street 1:6387 RAMSEY STREET
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28311
Practice Address - Country:US
Practice Address - Phone:910-615-3878
Practice Address - Fax:910-321-6219
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC102262363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
202616OtherMEDCOST
202616OtherMEDCOST
NC2761156CMedicare PIN
NC2761156BMedicare PIN