Provider Demographics
NPI:1023106770
Name:BATES, JOE BOYD (MD)
Entity type:Individual
Prefix:DR
First Name:JOE
Middle Name:BOYD
Last Name:BATES
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 1:1500 CORPORATE CIR STE 7
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5954
Mailing Address - Country:US
Mailing Address - Phone:817-677-0449
Mailing Address - Fax:817-677-0449
Practice Address - Street 1:1500 CORPORATE CIR STE 7
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5954
Practice Address - Country:US
Practice Address - Phone:417-761-5006
Practice Address - Fax:417-761-5065
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD79112084P0804X
MO20180324302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200059302Medicaid
E81030Medicare UPIN