Provider Demographics
NPI:1356444707
Name:GATES, AMY M (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:GATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:HALLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3500 GASTON AVE
Mailing Address - Street 2:4 ROBERTS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-2017
Mailing Address - Country:US
Mailing Address - Phone:214-820-3000
Mailing Address - Fax:214-820-3022
Practice Address - Street 1:3500 GASTON AVE
Practice Address - Street 2:4 ROBERTS
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2017
Practice Address - Country:US
Practice Address - Phone:214-820-3000
Practice Address - Fax:214-820-3022
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM4803208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8CZ858OtherBCBSTX
TX184286603Medicaid
TX184286604Medicaid
TX184286601Medicaid
TX8CZ858OtherBCBSTX
TXP01031852Medicare PIN
TX8F6172Medicare PIN
TX8L2205Medicare PIN
TXTXB133464Medicare PIN
TX184286604Medicaid
TXI69120Medicare UPIN