MEDICARE: DR. TODD JACOB GATES D.O.

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	2084P0800X	Psychiatry Physician	34-004091	OH
2	2084P0800X	Psychiatry Physician	OS10754	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992702260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD JACOB GATES D.O.

Provider Business Mailing Address
First Line	:	400 SHERIDAN RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-3184
Country	:	US
Telephone Number	:	321-722-5200
Fax Number	:	321-953-7510

Provider Business Practice Location Address
First Line	:	2020 COMMERCE DR
Second Line	:
City	:	WEST MELBOURNE
State	:	FL
Zip	:	32904-2335
Country	:	US
Telephone Number	:	321-952-6000
Fax Number	:

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

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	07/16/2021

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