Provider Demographics
NPI:1235192733
Name:BATES, NATHAN R (MD)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:R
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 1:1824 KING ST STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4736
Mailing Address - Country:US
Mailing Address - Phone:904-384-3343
Mailing Address - Fax:904-400-6671
Practice Address - Street 1:836 PRUDENTIAL DR
Practice Address - Street 2:STE 1804
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207
Practice Address - Country:US
Practice Address - Phone:904-398-3888
Practice Address - Fax:904-400-6675
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME99751208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00640795OtherMEDICARE RAILROAD
FL280171000Medicaid
FL280171000Medicaid
FLAJ065ZMedicare PIN
GA367006025AMedicaid