Provider Demographics
NPI:1689786832
Name:BATES, ERIK G (PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:G
Last Name:BATES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 CAPITOL ST NE
Mailing Address - Street 2:PO BOX 8100
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-0644
Mailing Address - Country:US
Mailing Address - Phone:503-399-2475
Mailing Address - Fax:503-375-7454
Practice Address - Street 1:2020 CAPITOL ST NE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301-0644
Practice Address - Country:US
Practice Address - Phone:503-399-2475
Practice Address - Fax:503-375-7454
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003991363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5542BAOtherREGENCE B/S PROV #
WA135580OtherLABOR&INDUSTRIES PROV #
WA135580OtherLABOR&INDUSTRIES PROV #
WAGAB15185Medicare ID - Type UnspecifiedMEDICARE PART B PROV #