Healthcare Provider Details

I. General information

NPI: 1598708331
Provider Name (Legal Business Name): CAPE RADIOLOGY GROUP I LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/20/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

IV. Provider business mailing address

70 DOCTORS PARK
CAPE GIRARDEAU MO
63703-4928
US

V. Phone/Fax

Practice location:
  • Phone: 573-334-6071
  • Fax: 573-334-4739
Mailing address:
  • Phone: 573-334-6071
  • Fax: 573-334-4739

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK L. GATES
Title or Position: PRESIDENT
Credential: MD
Phone: 573-334-6071