Provider Demographics
NPI:1275572992
Name:BATES, JIM D (DO)
Entity Type:Individual
Prefix:DR
First Name:JIM
Middle Name:D
Last Name:BATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:DR
Other - First Name:JAMES
Other - Middle Name:D
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:D O
Mailing Address - Street 1:2744 SILVERCREEK RD
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-7913
Mailing Address - Country:US
Mailing Address - Phone:928-704-7166
Mailing Address - Fax:928-704-7144
Practice Address - Street 1:1378 PIONEER TRL
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86429-1112
Practice Address - Country:US
Practice Address - Phone:928-234-4321
Practice Address - Fax:928-404-2150
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1897208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ227571Medicaid
AZ834640OtherBCBS
AZ330005009OtherMEDICARE RAILROAD
C98137Medicare UPIN
AZ834640OtherBCBS