Provider Demographics
NPI:1780678326
Name:BATES, ROBERT RAYMOND JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAYMOND
Last Name:BATES
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:CROW AGENCY
Mailing Address - State:MT
Mailing Address - Zip Code:59022-0009
Mailing Address - Country:US
Mailing Address - Phone:406-638-3467
Mailing Address - Fax:406-638-3569
Practice Address - Street 1:1 HOSPITAL WAY
Practice Address - Street 2:
Practice Address - City:CROW AGENCY
Practice Address - State:MT
Practice Address - Zip Code:59022
Practice Address - Country:US
Practice Address - Phone:406-638-3467
Practice Address - Fax:406-638-3569
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101058393207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA61554OtherMEDICAL LICENSE
VAVAA100528Medicare PIN