Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 0101037916 | VA |
NPI | 1649263757 |
---|---|
Provider Name | Dr. Charles Wayne Gates |
First Address | Harrisonburg, VA 22801-2685 |
Second Address | Harrisonburg, VA 22801-2685 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2005 |
Last Update Date | 03/11/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
006503403 | (05) | VA |
462160 | ANTHEM PROVIDER ID NUMBER (01) | VA |
B07954 | (02) | VA |