MEDICARE: JACK ALDRICH CATES MD

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	207N00000X	Dermatology Physician	R-2487	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50925	OTHER	AR	BLUE CROSS

General Provider Information

NPI Number	:	1750382958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK ALDRICH CATES MD

Provider Business Mailing Address
First Line	:	1710 MALVERN AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7132
Country	:	US
Telephone Number	:	501-624-3376
Fax Number	:	501-624-5609

Provider Business Practice Location Address
First Line	:	1710 MALVERN AVE
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-7132
Country	:	US
Telephone Number	:	501-624-3376
Fax Number	:	501-624-5609

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

Provider Enumeration Date	:	08/10/2005
Last Update Date	:	07/08/2007

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