Provider Demographics
NPI:1639179013
Name:BATES, EDWARD E (MD)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:E
Last Name:BATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:808 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7012
Mailing Address - Country:US
Mailing Address - Phone:817-558-3937
Mailing Address - Fax:817-641-6424
Practice Address - Street 1:1301 W HENDERSON ST STE A
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-5117
Practice Address - Country:US
Practice Address - Phone:817-558-3937
Practice Address - Fax:817-422-0862
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3552207P00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113352202Medicaid
TX113352205Medicaid
TX8505J2Medicare PIN
TX110205231OtherRAILROAD MEDICARE