Provider Demographics
NPI:1629146352
Name:BRIAN L GATES DPM PC
Entity Type:Organization
Organization Name:BRIAN L GATES DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:GATES
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:814-943-9885
Mailing Address - Street 1:521 LOGAN BOULEVARD LAKEMONT
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16602-5619
Mailing Address - Country:US
Mailing Address - Phone:814-943-9885
Mailing Address - Fax:814-943-5492
Practice Address - Street 1:521 LOGAN BOULEVARD LAKEMONT
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-5619
Practice Address - Country:US
Practice Address - Phone:814-943-9885
Practice Address - Fax:814-943-5492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2007-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC002225L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA084466OtherMEDICARE PROVIDER ID#
PAT29798Medicare UPIN
PA084466OtherMEDICARE PROVIDER ID#