Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 030093-1 | NY |
NPI | 1033115506 |
---|---|
Provider Name | Dr. Paul Gates |
First Address | Bronx, NY 10457-5524 |
Second Address | Bronx, NY 10457-5524 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2005 |
Last Update Date | 28/01/2013 |