MEDICARE: MR. ROBERT EDWARD GATES JR. L.AC, AP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	673-055	WI
2	171100000X	Acupuncturist	AP2809	FL

General Provider Information

NPI Number	:	1073824371
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT EDWARD GATES JR. L.AC, AP

Provider Business Mailing Address
First Line	:	1103 ERMINE AVE
Second Line	:
City	:	WINTER SPRINGS
State	:	FL
Zip	:	32708-4131
Country	:	US
Telephone Number	:	407-852-8584
Fax Number	:

Provider Business Practice Location Address
First Line	:	2040 WINTER SPRINGS BLVD
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-9347
Country	:	US
Telephone Number	:	407-852-8584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2010
Last Update Date	:	04/15/2011

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