MEDICARE: MR. ARTHUR R GATES III

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	172A00000X	Driver

General Provider Information

NPI Number	:	1831498351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARTHUR R GATES III

Provider Business Mailing Address
First Line	:	1807 ALICE WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2806
Country	:	US
Telephone Number	:	916-420-4499
Fax Number	:

Provider Business Practice Location Address
First Line	:	1807 ALICE WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95834-2806
Country	:	US
Telephone Number	:	916-420-4499
Fax Number	:

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

Provider Enumeration Date	:	03/23/2011
Last Update Date	:	09/13/2011

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