Provider Demographics
NPI:1679578108
Name:TATE, DAVID ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ANTHONY
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:KAPLAN
Mailing Address - State:LA
Mailing Address - Zip Code:70548-0790
Mailing Address - Country:US
Mailing Address - Phone:337-643-8096
Mailing Address - Fax:337-643-6046
Practice Address - Street 1:109 E 5TH ST
Practice Address - Street 2:
Practice Address - City:KAPLAN
Practice Address - State:LA
Practice Address - Zip Code:70548-4113
Practice Address - Country:US
Practice Address - Phone:337-643-8096
Practice Address - Fax:337-643-6046
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-21
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6145208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1093211Medicaid
LA1093211Medicaid
LA55316Medicare ID - Type Unspecified