Healthcare Provider Details

I. General information

NPI: 1730625146
Provider Name (Legal Business Name): MEGAN CATHLEEN BATES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2017
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MILITARY TRL STE 208
JUPITER FL
33458-4837
US

IV. Provider business mailing address

1995 E OAKLAND PARK BLVD STE 250
FORT LAUDERDALE FL
33306-1149
US

V. Phone/Fax

Practice location:
  • Phone: 561-795-3787
  • Fax:
Mailing address:
  • Phone: 954-791-6146
  • Fax: 954-337-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9110067
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: