Provider Demographics
NPI:1295745982
Name:BATES, JANET M (MD)
Entity type:Individual
Prefix:MRS
First Name:JANET
Middle Name:M
Last Name:BATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:89569 SUNNY LOOP LANE
Mailing Address - Street 2:
Mailing Address - City:BANDON
Mailing Address - State:OR
Mailing Address - Zip Code:97411
Mailing Address - Country:US
Mailing Address - Phone:541-297-1974
Mailing Address - Fax:512-342-9949
Practice Address - Street 1:1000 6TH ST SW
Practice Address - Street 2:
Practice Address - City:BANDON
Practice Address - State:OR
Practice Address - Zip Code:97411-9529
Practice Address - Country:US
Practice Address - Phone:541-297-1974
Practice Address - Fax:512-342-9949
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD19515207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG42082Medicare UPIN