Provider Demographics
NPI:1629038716
Name:BATES, DUANE A (PA)
Entity Type:Individual
Prefix:
First Name:DUANE
Middle Name:A
Last Name:BATES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:BOUNTIFUL
Mailing Address - State:UT
Mailing Address - Zip Code:84011-0307
Mailing Address - Country:US
Mailing Address - Phone:801-294-6907
Mailing Address - Fax:801-294-6917
Practice Address - Street 1:8822 S REDWOOD RD
Practice Address - Street 2:SUITE E122
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9336
Practice Address - Country:US
Practice Address - Phone:801-256-0009
Practice Address - Fax:801-256-1133
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2010-01-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
UT102857-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant