Provider Demographics
NPI:1477642569
Name:GATES, JOEL THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:THOMAS
Last Name:GATES
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 1:295 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:RIDGWAY
Mailing Address - State:CO
Mailing Address - Zip Code:81432-8706
Mailing Address - Country:US
Mailing Address - Phone:970-626-5123
Mailing Address - Fax:970-626-9783
Practice Address - Street 1:295 SHERMAN STREET
Practice Address - Street 2:
Practice Address - City:RIDGWAY
Practice Address - State:CO
Practice Address - Zip Code:81432
Practice Address - Country:US
Practice Address - Phone:970-626-5123
Practice Address - Fax:970-626-9783
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42428207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49079719Medicaid
CO841554989008OtherROCKY MOUNTAIN
CO49079719Medicaid
COI42056Medicare UPIN