Provider Demographics
NPI:1649305012
Name:TATE, JEFFREY LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LEWIS
Last Name:TATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:5311 VILLAGE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8102
Mailing Address - Country:US
Mailing Address - Phone:479-271-6511
Mailing Address - Fax:479-271-6518
Practice Address - Street 1:5311 VILLAGE PKWY
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8102
Practice Address - Country:US
Practice Address - Phone:479-271-6511
Practice Address - Fax:479-271-6518
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARN-83452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry