Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 25541 | NE |
Y | 207X00000X | Orthopaedic Surgeon | 258183 | NY |
N | 207X00000X | Orthopaedic Surgeon | MD436074 | PA |
NPI | 1013119528 |
---|---|
Provider Name | Dr. Charley B Gates |
First Address | Sayre, PA 18840-1625 |
Second Address | Cortland, NY 13045-1643 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 01/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10025863500 | (05) | NE |
34682 | BLUECROSS BLUESHIELD (01) | NE |
MD436074 | MD LICENSE (01) | PA |
P00840049 | RAILROAD MEDICARE (01) |