Provider Demographics
NPI:1245213727
Name:GATES, JOAN MISCH (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:MISCH
Last Name:GATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25400 LA RENA LN
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-4644
Mailing Address - Country:US
Mailing Address - Phone:650-949-4981
Mailing Address - Fax:650-949-1060
Practice Address - Street 1:2105 FOREST AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1425
Practice Address - Country:US
Practice Address - Phone:408-947-2616
Practice Address - Fax:408-947-3480
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37742207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G377420Medicare ID - Type Unspecified
CAC04214Medicare UPIN