Individual
TATE VERNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
673 MDG, 5955 ZEAMER AVENUE, JBER, AK 99506
(907) 580-5556
Mailing address
673 MDG, 5955 ZEAMER AVENUE, JBER, AK 99506
(907) 580-5556
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
U0678
TX
208D00000X
General Practice Physician
U0678
TX
Other
Enumeration date
03/03/2021
Last updated
10/28/2024
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