Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 24733 | MS |
Y | 207N00000X | Dermatologist | 304266 | LA |
N | 207ND0101X | MOHS-Micrographic Surgeon | 304266 | LA |
NPI | 1255697090 |
---|---|
Provider Name | Mr. David Allen Pate I |
First Address | Slidell, LA 70461-4250 |
Second Address | Slidell, LA 70461-4250 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/04/2012 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2199692 | (05) | LA |