Healthcare Provider Details

I. General information

NPI: 1467439943
Provider Name (Legal Business Name): BRUCE P BATES DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 02/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 MAIN ST
SACO ME
04072-1543
US

IV. Provider business mailing address

PO BOX 284
BRATTLEBORO VT
05302-0284
US

V. Phone/Fax

Practice location:
  • Phone: 207-602-3571
  • Fax: 207-602-3573
Mailing address:
  • Phone: 207-784-2554
  • Fax: 207-777-5363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number896
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: