Individual
JODI T TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
32740
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0232074
—
IA
01
—
28257
WELLMARK BCBS
—
Enumeration date
09/19/2005
Last updated
12/19/2007
Update your record
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