Individual
BRENT TYLER TATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-2056
Mailing address
2501 CAPEHART RD, OFFUTT AFB, NE 68113-1043
(402) 294-2056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
9586
NE
390200000X
Student in an Organized Health Care Education/Training Program
Primary
9586
NE
Other
Enumeration date
05/24/2023
Last updated
06/28/2023
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