Provider Demographics
NPI:1225332026
Name:DAVID M. BATES, DPM, PLLC
Entity Type:Organization
Organization Name:DAVID M. BATES, DPM, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:623-243-5737
Mailing Address - Street 1:15182 N 75TH AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4722
Mailing Address - Country:US
Mailing Address - Phone:623-243-5737
Mailing Address - Fax:623-399-4091
Practice Address - Street 1:15182 N 75TH AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4722
Practice Address - Country:US
Practice Address - Phone:623-243-5737
Practice Address - Fax:623-399-4091
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-07
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0592213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6489450001Medicare NSC