Healthcare Provider Details

I. General information

NPI: 1023072915
Provider Name (Legal Business Name): THOMAS CHARLES GATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 ELM AVE
LONG BEACH CA
90813-3271
US

IV. Provider business mailing address

PO BOX 575
MURRIETA CA
92564-0575
US

V. Phone/Fax

Practice location:
  • Phone: 951-691-5123
  • Fax: 951-691-5156
Mailing address:
  • Phone: 951-691-5123
  • Fax: 951-691-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberA23750
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: