Individual
SHAWN TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1400 N 500 E, LOGAN, UT 84341
(415) 833-9182
Mailing address
PO BOX 27128, SALT LAKE CITY, UT 84127-0128
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
6238119-1205
UT
Other
Enumeration date
03/25/2014
Last updated
05/17/2018
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