Healthcare Provider Details

I. General information

NPI: 1174692206
Provider Name (Legal Business Name): JAMES ERIC BATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 04/13/2022
Certification Date: 04/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DR STE 104
SAN DIEGO CA
92120-5198
US

IV. Provider business mailing address

5555 RESERVOIR DR STE 104
SAN DIEGO CA
92120-5198
US

V. Phone/Fax

Practice location:
  • Phone: 619-286-9480
  • Fax: 619-286-4568
Mailing address:
  • Phone: 619-286-6930
  • Fax: 619-286-9438

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberG73930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: