Individual
DORIAN RAYMONE TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7950 W JEFFERSON BLVD, FORT WAYNE, IN 46804-4140
(260) 435-7001
Mailing address
5437 COVENTRY LN APT 207, FORT WAYNE, IN 46804-7177
(404) 401-5338
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
258404
AZ
367500000X
Certified Registered Nurse Anesthetist
PENDING
IN
Other
Enumeration date
10/26/2020
Last updated
06/24/2021
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