Individual
JONATHAN MICHAEL TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2801 N GANTENBEIN AVE, PORTLAND, OR 97227-1623
(503) 413-8407
Mailing address
PO BOX 3777, PORTLAND, OR 97208-3777
(503) 413-8407
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
161824
OR
Other
Enumeration date
03/05/2007
Last updated
09/23/2014
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