Healthcare Provider Details

I. General information

NPI: 1477642569
Provider Name (Legal Business Name): JOEL THOMAS GATES D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 SHERMAN STREET
RIDGWAY CO
81432
US

IV. Provider business mailing address

295 SHERMAN ST
RIDGWAY CO
81432-8706
US

V. Phone/Fax

Practice location:
  • Phone: 970-626-5123
  • Fax: 970-626-9783
Mailing address:
  • Phone: 970-626-5123
  • Fax: 970-626-9783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42428
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: