Provider Demographics
NPI:1831151786
Name:BATES, JONATHAN JAMES (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:BATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6401 UNIVERSITY AVE NE
Mailing Address - Street 2:
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432-4341
Mailing Address - Country:US
Mailing Address - Phone:763-572-5710
Mailing Address - Fax:763-571-3008
Practice Address - Street 1:10000 ZANE AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55443-1400
Practice Address - Country:US
Practice Address - Phone:763-572-5710
Practice Address - Fax:763-569-6200
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN41568207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN546316500Medicaid
MN0104111OtherMEDICA
MN68D53BAOtherBCBS OF MN
MN1020259OtherPREFERRED ONE
MNHP28999OtherHEALTHPARTNERS
MN6603833OtherMEDICA UC NUMBER
MN7711010OtherAETNA
MN850757OtherAMERICA'S PPO
MN123620OtherUCARE MN
MN080008041Medicare ID - Type Unspecified
MN6603833OtherMEDICA UC NUMBER
MNHP28999OtherHEALTHPARTNERS