Healthcare Provider Details

I. General information

NPI: 1659363133
Provider Name (Legal Business Name): ROBERT L GATES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2005
Last Update Date: 05/14/2021
Certification Date: 05/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 CROSS PARK CT
GREENVILLE SC
29605-4263
US

IV. Provider business mailing address

300 E MCBEE AVE
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 864-797-7400
  • Fax: 864-797-7405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number33172
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: