Provider Demographics
NPI:1710259767
Name:GATES FAMILY MEDICINE, LLC
Entity Type:Organization
Organization Name:GATES FAMILY MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICKEY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-426-1290
Mailing Address - Street 1:2870 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14624-1340
Mailing Address - Country:US
Mailing Address - Phone:585-426-1290
Mailing Address - Fax:585-426-2597
Practice Address - Street 1:2870 BUFFALO RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14624-1340
Practice Address - Country:US
Practice Address - Phone:585-426-1290
Practice Address - Fax:585-426-2597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ100070582Medicare PIN