1902802697 NPI number — STEPHEN I. GATES M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902802697 NPI number — STEPHEN I. GATES M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GATES

Provider First Name:

STEPHEN

Provider Middle Name:

I.

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

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:

1902802697

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

06/03/2026

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

36014 TH ST

Provider Second Line Business Mailing Address:

STOP 8143

Provider Business Mailing Address City Name:

LUBBOCK

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

79430-8143

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

806-743-2757

Provider Business Mailing Address Fax Number:

806-743-1071

Provider First Line Business Practice Location Address:

3800 WOODBRIAR TRL FL 32129

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

PORT ORANGE

Provider Business Practice Location Address State Name:

FL

Provider Business Practice Location Address Postal Code:

32129-9626

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

386-322-4701

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

06/27/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207LH0002X , with the licence number:  ME181421 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207L00000X , with the licence number: F6654 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207LH0002X , with the licence number: F6654 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 113392100 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 52362 . This is a "PRESBYTERIAN COMMERCIAL" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
• Identifier: A229 . This is a "TRIWEST" identifier . This identifiers is of the category "OTHER".
• Identifier: 100162480A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
• Identifier: 80946Z . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 87172G . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 113392101 . This is a "FIRSTCARE COMMERCIAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 136881307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 136881308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 52362 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
• Identifier: H3719 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".