Healthcare Provider Details

I. General information

NPI: 1477510733
Provider Name (Legal Business Name): STEPHEN R BATES M.D,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 10/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CHURCH ST STE 400
JONESBORO AR
72401-4176
US

IV. Provider business mailing address

800 S CHURCH ST STE 400
JONESBORO AR
72401-4176
US

V. Phone/Fax

Practice location:
  • Phone: 870-935-6012
  • Fax: 870-934-3156
Mailing address:
  • Phone: 870-935-6012
  • Fax: 870-934-3156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberR3471
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: