Individual
DR. CRYSTAL LANE TATE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
375 MAIN ST, ECRU, MS 38841-9118
(662) 489-5609
(662) 489-3814
Mailing address
PO BOX 492, ECRU, MS 38841-0492
(662) 489-5609
(662) 489-3814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
13565
MS
Other
Enumeration date
03/17/2006
Last updated
12/04/2008
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