Provider Demographics
NPI:1750382958
Name:CATES, JACK ALDRICH (MD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:ALDRICH
Last Name:CATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1710 MALVERN AVE
Mailing Address - Street 2:
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71901-7132
Mailing Address - Country:US
Mailing Address - Phone:501-624-3376
Mailing Address - Fax:501-624-5609
Practice Address - Street 1:1710 MALVERN AVE
Practice Address - Street 2:
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71901-7132
Practice Address - Country:US
Practice Address - Phone:501-624-3376
Practice Address - Fax:501-624-5609
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-2487207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR50925OtherBLUE CROSS
D04435Medicare UPIN