Healthcare Provider Details

I. General information

NPI: 1831498351
Provider Name (Legal Business Name): MR. ARTHUR R GATES III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 09/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1807 ALICE WAY
SACRAMENTO CA
95834-2806
US

IV. Provider business mailing address

1807 ALICE WAY
SACRAMENTO CA
95834-2806
US

V. Phone/Fax

Practice location:
  • Phone: 916-420-4499
  • Fax:
Mailing address:
  • Phone: 916-420-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: