Healthcare Provider Details

I. General information

NPI: 1821075151
Provider Name (Legal Business Name): E JASON GATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 E COMMERCIAL BLVD STE 101
FORT LAUDERDALE FL
33308-4202
US

IV. Provider business mailing address

2800 E COMMERCIAL BLVD STE 101
FORT LAUDERDALE FL
33308-4202
US

V. Phone/Fax

Practice location:
  • Phone: 954-771-8888
  • Fax: 855-618-2354
Mailing address:
  • Phone: 954-771-8888
  • Fax: 855-618-2354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberME73437
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: