Healthcare Provider Details

I. General information

NPI: 1376742346
Provider Name (Legal Business Name): JASON ANDREW PATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JASON ANDREW PATES MD

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 03/18/2025
Certification Date: 03/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 W IRONWOOD DR STE 306
COEUR D ALENE ID
83814
US

IV. Provider business mailing address

2003 KOOTENAI HEALTH WAY
COEUR D ALENE ID
83814-6051
US

V. Phone/Fax

Practice location:
  • Phone: 208-625-4970
  • Fax: 208-625-4991
Mailing address:
  • Phone: 208-625-4970
  • Fax: 208-625-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberM-12184
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number60305
License Number StateMN
# 3
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD60080627
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number60305
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: