Provider Demographics
NPI:1093733834
Name:MATES, ELISABETH A (MD)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:A
Last Name:MATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ELISABETH
Other - Middle Name:A
Other - Last Name:VANLOBENSELS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3299
Mailing Address - Street 2:
Mailing Address - City:CARSON CITY
Mailing Address - State:NV
Mailing Address - Zip Code:89702-3299
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:509-665-6065
Practice Address - Street 1:1600 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:CARSON CITY
Practice Address - State:NV
Practice Address - Zip Code:89703-4625
Practice Address - Country:US
Practice Address - Phone:775-445-8795
Practice Address - Fax:775-445-5175
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00037050208M00000X
NV15457208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8239931Medicaid
WA0177914OtherL&I
WAG98312Medicare UPIN
WA0177914OtherL&I
WA8239931Medicaid