Individual
TATE JAMES PERQUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1453 E BERT KOUNS INDUSTRIAL LOOP STE 318, SHREVEPORT, LA 71105-6810
(318) 681-1968
(318) 681-1969
Mailing address
2900 SAINT MICHAEL DR STE 401, TEXARKANA, TX 75503-5211
(903) 614-5368
(903) 614-5343
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA200387
LA
363AS0400X
Surgical Physician Assistant
PA.200387
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2125362
—
LA
Enumeration date
09/24/2010
Last updated
07/28/2020
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