Provider Demographics
NPI:1336135177
Name:BATES, DAVID M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:BATES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15182 N 75TH AVE STE 160
Mailing Address - Street 2:
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:STE 160
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
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ0592213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ860371Medicaid
AZ860371Medicaid
AZZ100434Medicare PIN