Provider Demographics
NPI:1508893629
Name:GATES, JANICE S (DPM)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:S
Last Name:GATES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 N 4TH AVE E
Mailing Address - Street 2:SUITE 200
Mailing Address - City:NEWTON
Mailing Address - State:IA
Mailing Address - Zip Code:50208-3155
Mailing Address - Country:US
Mailing Address - Phone:641-792-2112
Mailing Address - Fax:641-792-8484
Practice Address - Street 1:300 N 4TH AVE E
Practice Address - Street 2:SUITE 200
Practice Address - City:NEWTON
Practice Address - State:IA
Practice Address - Zip Code:50208-3155
Practice Address - Country:US
Practice Address - Phone:641-792-2112
Practice Address - Fax:641-792-8484
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00573213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1109405Medicaid
IA1109405Medicaid
IA49791Medicare ID - Type Unspecified