Provider Demographics
NPI:1902005184
Name:TATE, HAROLD A (MD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:A
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 1:8680 MESA CANOGO DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1444
Mailing Address - Country:US
Mailing Address - Phone:702-429-2050
Mailing Address - Fax:702-253-7834
Practice Address - Street 1:8680 MESA CANOGO DRIVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1444
Practice Address - Country:US
Practice Address - Phone:702-429-2050
Practice Address - Fax:702-253-7834
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL59712085R0204X
CAG745832085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFR715ZMedicare PIN
NVH27431Medicare UPIN