Healthcare Provider Details

I. General information

NPI: 1780678326
Provider Name (Legal Business Name): ROBERT RAYMOND BATES JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HOSPITAL WAY
CROW AGENCY MT
59022
US

IV. Provider business mailing address

PO BOX 9
CROW AGENCY MT
59022-0009
US

V. Phone/Fax

Practice location:
  • Phone: 406-638-3467
  • Fax: 406-638-3569
Mailing address:
  • Phone: 406-638-3467
  • Fax: 406-638-3569

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101058393
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: