Provider Demographics
NPI:1821324518
Name:GATES, GARY FRANKLIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:FRANKLIN
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 1:2531 NW JONATHAN PLACE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-4471
Mailing Address - Country:US
Mailing Address - Phone:503-533-5189
Mailing Address - Fax:
Practice Address - Street 1:2531 NW JONATHAN PLACE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-4471
Practice Address - Country:US
Practice Address - Phone:503-533-5189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10243207U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR263749Medicaid
OR263749Medicaid
OR263749Medicaid
00WCJBHAMedicare PIN