Individual
JEFFERY D TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
555 W 6TH ST, MOUNTAIN HOME, AR 72653-3409
(870) 425-8288
(870) 425-8299
Mailing address
759 HIGHWAY 62 E, MOUNTAIN HOME, AR 72653-3260
(870) 594-8387
(870) 701-5045
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA-354
STATE MEDICAL BOARD - P.A. LICENSE
AR
Enumeration date
07/05/2007
Last updated
10/27/2023
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