Provider Demographics
NPI:1912453895
Name:PATE, DAVID DYLAN (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:DYLAN
Last Name:PATE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:15 FOUNDERS LN STE 100
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62650-3924
Mailing Address - Country:US
Mailing Address - Phone:217-243-0300
Mailing Address - Fax:217-862-0202
Practice Address - Street 1:15 FOUNDERS LN STE 100
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-3924
Practice Address - Country:US
Practice Address - Phone:217-243-0300
Practice Address - Fax:217-862-0202
Is Sole Proprietor?:No
Enumeration Date:2016-08-30
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085005952363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical