Provider Demographics
NPI:1881664910
Name:BATES, WENDELL REESE
Entity Type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:REESE
Last Name:BATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7030 BEAUVOIR CT
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70128-2504
Mailing Address - Country:US
Mailing Address - Phone:504-342-2342
Mailing Address - Fax:
Practice Address - Street 1:400 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70143-5077
Practice Address - Country:US
Practice Address - Phone:504-678-3660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman