Provider Demographics
NPI:1427388065
Name:GATES, DAVIS FESSENDEN (MD)
Entity Type:Individual
Prefix:
First Name:DAVIS
Middle Name:FESSENDEN
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 OSCEOLA DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-6729
Mailing Address - Country:US
Mailing Address - Phone:239-332-1234
Mailing Address - Fax:239-332-1234
Practice Address - Street 1:1255 OSCEOLA DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-6729
Practice Address - Country:US
Practice Address - Phone:239-332-1234
Practice Address - Fax:239-332-1234
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-04
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12912208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty