Provider Demographics
NPI:1902802697
Name:GATES, STEPHEN I (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:I
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36014 TH ST
Mailing Address - Street 2:STOP 8143
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-8143
Mailing Address - Country:US
Mailing Address - Phone:806-743-2757
Mailing Address - Fax:806-743-1071
Practice Address - Street 1:3601 4TH ST # MS 8143
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-0001
Practice Address - Country:US
Practice Address - Phone:806-743-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6654207L00000X, 207LH0002X, 207QH0002X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LH0002XAllopathic & Osteopathic PhysiciansAnesthesiologyHospice and Palliative Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX113392100Medicaid
NM52362OtherPRESBYTERIAN COMMERCIAL
A229OtherTRIWEST
OK100162480AMedicaid
TX80946ZOtherHMO BLUE
TX87172GOtherBC/BS
TX113392101OtherFIRSTCARE COMMERCIAL
TX136881307Medicaid
TX136881308Medicaid
NM52362Medicaid
NMH3719Medicaid
A229OtherTRIWEST
TX113392101OtherFIRSTCARE COMMERCIAL
NMH3719Medicaid