Provider Demographics
NPI:1104860295
Name:BATES, PHILIP DEAN (MD)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:DEAN
Last Name:BATES
Suffix:
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 1:3714 GUARDIAN AVE.
Mailing Address - Street 2:STE E
Mailing Address - City:MOREHEAD CITY
Mailing Address - State:NC
Mailing Address - Zip Code:28557
Mailing Address - Country:US
Mailing Address - Phone:252-247-2101
Mailing Address - Fax:252-247-4675
Practice Address - Street 1:3714 GUARDIAN AVE
Practice Address - Street 2:STE E
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557-4322
Practice Address - Country:US
Practice Address - Phone:252-247-2101
Practice Address - Fax:252-247-4675
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00305208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5911210Medicaid
NC5911210Medicaid