Provider Demographics
NPI:1982754933
Name:BATES, GAYLON MURRELL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLON
Middle Name:MURRELL
Last Name:BATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GAYLON
Other - Middle Name:MURRELL
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:400 DOWNS LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-7784
Mailing Address - Country:US
Mailing Address - Phone:318-487-4302
Mailing Address - Fax:
Practice Address - Street 1:100 PINECREST DRIVE
Practice Address - Street 2:PINECREST DEVELOMENTAL CENTER
Practice Address - City:PINEVILLE
Practice Address - State:LA
Practice Address - Zip Code:71361-5191
Practice Address - Country:US
Practice Address - Phone:318-641-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA07224R208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics