Provider Demographics
NPI:1285875328
Name:PATE, ALLEN CHRISTOPHER (IDC)
Entity type:Individual
Prefix:MR
First Name:ALLEN
Middle Name:CHRISTOPHER
Last Name:PATE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NAVAL OPERATIONAL MEDICINE INSTITUTE BOX 555223
Mailing Address - Street 2:DETACHMENT NAVAL EXPEDITIONARY MEDICAL TRAINING INST.
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5223
Mailing Address - Country:US
Mailing Address - Phone:760-725-7121
Mailing Address - Fax:760-725-7108
Practice Address - Street 1:NAVAL OPERATIONAL MEDICINE INSTITUTE BUILDING 632044
Practice Address - Street 2:DETACHMENT NAVAL EXPEDITIONARY MEDICAL TRAINING INST.
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5223
Practice Address - Country:US
Practice Address - Phone:760-725-7121
Practice Address - Fax:760-725-7108
Is Sole Proprietor?:No
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA191414164W00000X
CA1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No164W00000XNursing Service ProvidersLicensed Practical Nurse