Individual
SUSAN J TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
4076 NEELY ROAD, FORT WAINWRIGHT, AK 99703
(907) 361-5479
Mailing address
4076 NEELY ROAD, FT WAINWRIGHT, AK 99703
(907) 361-5689
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
4295
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
MD0991
—
AK
Enumeration date
09/30/2005
Last updated
05/28/2025
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