Healthcare Provider Details

I. General information

NPI: 1972509487
Provider Name (Legal Business Name): JAMES R GATES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 11/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1293 E PARKDALE AVE STE 2300B
MANISTEE MI
49660-8904
US

IV. Provider business mailing address

375 RIVER ST
MANISTEE MI
49660-2729
US

V. Phone/Fax

Practice location:
  • Phone: 231-398-1750
  • Fax: 231-398-1751
Mailing address:
  • Phone: 231-398-9266
  • Fax: 231-398-9268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301046368
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: