Provider Demographics
NPI:1417901968
Name:GATES, RACHAEL L (DO)
Entity Type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:L
Last Name:GATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:RACHAEL
Other - Middle Name:L
Other - Last Name:WEIDERHOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4001 E SUNRISE DR STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-4324
Mailing Address - Country:US
Mailing Address - Phone:520-209-7000
Mailing Address - Fax:520-209-7010
Practice Address - Street 1:4001 E SUNRISE DR STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-4324
Practice Address - Country:US
Practice Address - Phone:520-209-7000
Practice Address - Fax:520-209-7010
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI32395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI391737080OtherWORKERS COMP
WI820549414010OtherBLUE CROSS BLUE SHIELD
WI3057700Medicaid
WI391737080OtherWORKERS COMP
WIF52374Medicare UPIN