Provider Demographics
NPI:1093451353
Name:GATES, CYRUS PALMER
Entity Type:Individual
Prefix:
First Name:CYRUS
Middle Name:PALMER
Last Name:GATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 N INTERSTATE 35 E
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5225
Mailing Address - Country:US
Mailing Address - Phone:469-297-4501
Mailing Address - Fax:
Practice Address - Street 1:219 N INTERSTATE 35 E
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-5225
Practice Address - Country:US
Practice Address - Phone:469-297-4501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-10
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1002470332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies