Provider Demographics
NPI:1659359842
Name:BATES, PAUL KENNETH JR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KENNETH
Last Name:BATES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:240 18TH STREET CIR SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-1361
Mailing Address - Country:US
Mailing Address - Phone:828-322-2550
Mailing Address - Fax:828-322-7748
Practice Address - Street 1:240 18TH STREET CIR SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-1361
Practice Address - Country:US
Practice Address - Phone:828-322-2550
Practice Address - Fax:828-322-7748
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC19206208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC13765OtherBCBS
NC8913765Medicaid
NC19206OtherNC MEDICAL LICENSE
NCF39685Medicare UPIN