Provider Demographics
NPI:1932164134
Name:BATES, ELIZABETH V (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:BATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9409 NORTON COMMONS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:PROSPECT
Mailing Address - State:KY
Mailing Address - Zip Code:40059-7525
Mailing Address - Country:US
Mailing Address - Phone:502-751-8577
Mailing Address - Fax:502-290-2862
Practice Address - Street 1:9409 NORTON COMMONS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PROSPECT
Practice Address - State:KY
Practice Address - Zip Code:40059-7525
Practice Address - Country:US
Practice Address - Phone:502-751-8577
Practice Address - Fax:502-290-2862
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY36808207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200451680Medicaid
KY64037856Medicaid
KY110228063OtherRAILROAD MEDICARE
KY64037856Medicaid
KY0691005Medicare PIN
KY00546223Medicare Oscar/Certification
KY1361901Medicare PIN