Basic Information
Provider Information | |||||||||
NPI: | 1437278041 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ROBERT DANIEL GATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ENCOMPASS OFFICE SOLUTIONS, INC. | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6966 S UTICA AVE | ||||||||
Address2: | STE 225 | ||||||||
City: | TULSA | ||||||||
State: | OK | ||||||||
PostalCode: | 741363903 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9184926333 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 2605 FOXBORO | ||||||||
Address2: |   | ||||||||
City: | MCKINNEY | ||||||||
State: | TX | ||||||||
PostalCode: | 750704329 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9726687460 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/28/2007 | ||||||||
LastUpdateDate: | 08/17/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GATES | ||||||||
AuthorizedOfficialFirstName: | ROBERT | ||||||||
AuthorizedOfficialMiddleName: | DANIEL | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
AuthorizedOfficialTelephone: | 9726687460 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZS0410X |   |   | Y | 193200000X MULTI-SPECIALTY GROUP |   |   |   |
ID Information
ID | Type | State | Issuer | Description | 471454 | 01 | TX | THE JOINT COMMISSION | OTHER |