Provider Demographics
NPI:1003818246
Name:BATES, KATHRYN L (DO)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:L
Last Name:BATES
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:1601 N SWAN RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4046
Mailing Address - Country:US
Mailing Address - Phone:520-615-1023
Mailing Address - Fax:520-320-1742
Practice Address - Street 1:6567 E CARONDELET DR STE 225
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-6154
Practice Address - Country:US
Practice Address - Phone:520-886-3432
Practice Address - Fax:520-886-0169
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3187207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI04691Medicare UPIN
AZZ80296Medicare PIN