Provider Demographics
NPI:1093794422
Name:GATES, JAMES (PA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:GATES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2202 N FORBES BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1412
Mailing Address - Country:US
Mailing Address - Phone:520-622-5912
Mailing Address - Fax:520-791-2246
Practice Address - Street 1:395 N SILVERBELL RD
Practice Address - Street 2:SUITE 355
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2656
Practice Address - Country:US
Practice Address - Phone:520-622-5912
Practice Address - Fax:520-791-2246
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1481363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ450338Medicaid
R74249Medicare UPIN
AZ104478Medicare PIN