Provider Demographics
NPI:1033479233
Name:BATES, PHILLIP DALE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILLIP
Middle Name:DALE
Last Name:BATES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2006 FRANKLIN ST SE STE 200
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-4537
Mailing Address - Country:US
Mailing Address - Phone:256-539-0457
Mailing Address - Fax:256-539-5827
Practice Address - Street 1:2006 FRANKLIN ST SE STE 200
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-4537
Practice Address - Country:US
Practice Address - Phone:256-539-0457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-21
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN570122085R0202X
AL357862085R0202X
FL17298390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL215931Medicaid
AL242511Medicaid
AL215919Medicaid
AL216279Medicaid
AL214554Medicaid
AL216553Medicaid
AL242938Medicaid
AL216152Medicaid
AL243047Medicaid
AL239940Medicaid
AL242772Medicaid
AL215913Medicaid
AL216277Medicaid
AL217392Medicaid
14192005OtherCAQH
AL244034Medicaid
AL216301Medicaid