Provider Demographics
NPI:1972509487
Name:GATES, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:375 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-2729
Mailing Address - Country:US
Mailing Address - Phone:231-398-9266
Mailing Address - Fax:231-398-9268
Practice Address - Street 1:1293 E PARKDALE AVE
Practice Address - Street 2:STE 2300B
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-8904
Practice Address - Country:US
Practice Address - Phone:231-398-1750
Practice Address - Fax:231-398-1751
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301046368207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4743229Medicaid
MI2005115171OtherBCBSM
MIE16002093Medicare PIN
MI2005115171OtherBCBSM