Provider Demographics
NPI:1477540532
Name:BATES, RONALD JAMES (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:JAMES
Last Name:BATES
Suffix:
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 1:409 VIRGINIA DRIVE
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501
Mailing Address - Country:US
Mailing Address - Phone:870-793-3400
Mailing Address - Fax:870-793-7737
Practice Address - Street 1:409 VIRGINIA DRIVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501
Practice Address - Country:US
Practice Address - Phone:870-793-3400
Practice Address - Fax:870-793-7737
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8409207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR124808003Medicaid
AR124808003Medicaid
F36294Medicare UPIN