MEDICARE: IAN ANDREW BATES PA-C

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	363AM0700X	Medical Physician Assistant	6838	AZ

General Provider Information

NPI Number	:	1427577873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IAN ANDREW BATES PA-C

Provider Business Mailing Address
First Line	:	1152 N ESTRADA
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85207-4477
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1855 N STAPLEY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85203-3002
Country	:	US
Telephone Number	:	480-834-7546
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	09/18/2017

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