Healthcare Provider Details

I. General information

NPI: 1184815722
Provider Name (Legal Business Name): JEFFREY JAMES GATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2007
Last Update Date: 12/01/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S PAVILION III, DEPT OF ORTHOPAEDIC SURGERY
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DR S PAVILION III, DEPT OF ORTHOPAEDIC SURGERY
ORANGE CA
92868-3201
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-7012
  • Fax: 714-456-8711
Mailing address:
  • Phone: 714-456-7012
  • Fax: 714-456-8711

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA92247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: