Provider Demographics
NPI:1730874249
Name:TATE, DILLON MICHAEL (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:MICHAEL
Last Name:TATE
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1728 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:HALEYVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35565-1506
Mailing Address - Country:US
Mailing Address - Phone:205-485-7822
Mailing Address - Fax:260-399-4004
Practice Address - Street 1:1728 11TH AVE
Practice Address - Street 2:
Practice Address - City:HALEYVILLE
Practice Address - State:AL
Practice Address - Zip Code:35565-1506
Practice Address - Country:US
Practice Address - Phone:205-465-7822
Practice Address - Fax:260-399-4004
Is Sole Proprietor?:No
Enumeration Date:2023-04-10
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906197207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine