Provider Demographics
NPI:1285862235
Name:GATES, CAMERON HERSCHEL JR (DO)
Entity Type:Individual
Prefix:DR
First Name:CAMERON
Middle Name:HERSCHEL
Last Name:GATES
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1005
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78667-1005
Mailing Address - Country:US
Mailing Address - Phone:512-396-8565
Mailing Address - Fax:
Practice Address - Street 1:1330 WONDER WORLD DR STE 202
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7590
Practice Address - Country:US
Practice Address - Phone:512-396-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN50702085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology