Healthcare Provider Details

I. General information

NPI: 1932164134
Provider Name (Legal Business Name): ELIZABETH V. BATES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409 NORTON COMMONS BLVD STE 101
PROSPECT KY
40059-7525
US

IV. Provider business mailing address

9409 NORTON COMMONS BLVD STE 101
PROSPECT KY
40059-7525
US

V. Phone/Fax

Practice location:
  • Phone: 502-751-8577
  • Fax: 502-290-2862
Mailing address:
  • Phone: 502-751-8577
  • Fax: 502-290-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36808
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: