1306054176 NPI number — W BRAD GATES MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306054176 NPI number — W BRAD GATES MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
W BRAD GATES MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306054176
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3108 MIDWAY RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-6383
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-801-9100
Provider Business Mailing Address Fax Number:
972-378-4846

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3108 MIDWAY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-6383
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-801-9100
Provider Business Practice Location Address Fax Number:
972-378-4846
Provider Enumeration Date:
05/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GATES
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-801-9100

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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