Provider Demographics
NPI:1790853133
Name:GATES, JOHNNY L (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:L
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:707 N ZANG BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-4337
Mailing Address - Country:US
Mailing Address - Phone:214-941-7467
Mailing Address - Fax:214-946-1123
Practice Address - Street 1:707 N ZANG BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-4337
Practice Address - Country:US
Practice Address - Phone:214-941-7467
Practice Address - Fax:214-946-1123
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXF5208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC16022Medicare UPIN
TX00JT23Medicare ID - Type Unspecified