Provider Demographics
NPI:1821217167
Name:GATES, DOUGLAS HART (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:HART
Last Name:GATES
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 1:80 HEALTHCARE DR
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5126
Mailing Address - Country:US
Mailing Address - Phone:828-586-5531
Mailing Address - Fax:828-586-5759
Practice Address - Street 1:80 HEALTHCARE DR
Practice Address - Street 2:SUITE 203
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5126
Practice Address - Country:US
Practice Address - Phone:828-586-5531
Practice Address - Fax:828-586-5759
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2012-01383207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5921746Medicaid
NC1747MOtherBCBS NC
NC5921746Medicaid