Healthcare Provider Details

I. General information

NPI: 1043291438
Provider Name (Legal Business Name): ROBERT G. GATES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1979 SNYDER ST SUITE 150
RICHLAND WA
99354-5319
US

IV. Provider business mailing address

4104 W HENRY ST
PASCO WA
99301-2908
US

V. Phone/Fax

Practice location:
  • Phone: 509-376-6853
  • Fax: 509-372-0522
Mailing address:
  • Phone: 509-545-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA10003275
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: