Provider Demographics
NPI:1649452830
Name:GATES, GERALD M (CRNA)
Entity type:Individual
Prefix:
First Name:GERALD
Middle Name:M
Last Name:GATES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10711 SPIRIT HORSE
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3997
Mailing Address - Country:US
Mailing Address - Phone:210-838-7370
Mailing Address - Fax:
Practice Address - Street 1:10711 SPIRIT HORSE
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-3997
Practice Address - Country:US
Practice Address - Phone:210-838-7370
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX735894207L00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8131UUOtherBCBS
TXP00710248OtherRAILROAD
TX193547004Medicaid
TX193547004Medicaid