Provider Demographics
NPI:1821092412
Name:BATES, JAMES H (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:H
Last Name:BATES
Suffix:
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 1:2690 S EAGLE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6704
Mailing Address - Country:US
Mailing Address - Phone:208-401-1000
Mailing Address - Fax:208-401-1010
Practice Address - Street 1:2690 S EAGLE RD STE 150
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6704
Practice Address - Country:US
Practice Address - Phone:208-401-1000
Practice Address - Fax:208-401-1010
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-10
Last Update Date:2014-04-02
Deactivation Date:2006-03-24
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
IDM7754208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID805574800Medicaid
IDG86170Medicare UPIN
ID805574800Medicaid