1417901968 NPI number — DR. RACHAEL L GATES D.O.

Table of content: DR. RACHAEL L GATES D.O. (NPI 1417901968)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417901968 NPI number — DR. RACHAEL L GATES D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATES
Provider First Name:
RACHAEL
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEIDERHOLD
Provider Other First Name:
RACHAEL
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.O.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1417901968
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4001 E SUNRISE DR STE 121
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TUCSON
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85718-4324
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-209-7000
Provider Business Mailing Address Fax Number:
520-209-7010

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4001 E SUNRISE DR STE 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85718-4324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-209-7000
Provider Business Practice Location Address Fax Number:
520-209-7010
Provider Enumeration Date:
05/20/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  32395 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 391737080 . This is a "WORKERS COMP" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 820549414010 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 3057700 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".