Basic Information
| Provider Information | |||||||||
| NPI: | 1043484462 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NICE | ||||||||
| FirstName: | TATE | ||||||||
| MiddleName: | RICHARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4499 MEDICAL DR STE 347 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106158757 | ||||||||
| FaxNumber: | 2106158789 | ||||||||
| Practice Location | |||||||||
| Address1: | 4499 MEDICAL DR STE 347 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106158757 | ||||||||
| FaxNumber: | 2106158789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2008 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | 32521 | AL | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.