Provider Demographics
NPI:1487640710
Name:SCATES, EDWARD G (DPM)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:SCATES
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7510
Mailing Address - Country:US
Mailing Address - Phone:602-955-4515
Mailing Address - Fax:602-955-7096
Practice Address - Street 1:3832 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7510
Practice Address - Country:US
Practice Address - Phone:602-955-4515
Practice Address - Fax:602-955-7096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZDPM326213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZDPM326Medicare ID - Type Unspecified
T88251Medicare UPIN