Provider Demographics
NPI:1538573571
Name:BATES, TYLER M (DO)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:M
Last Name:BATES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28583 DUPONT BLVD, UNIT 1
Mailing Address - Street 2:
Mailing Address - City:MILLSBORO
Mailing Address - State:DE
Mailing Address - Zip Code:19966-1223
Mailing Address - Country:US
Mailing Address - Phone:302-934-0944
Mailing Address - Fax:302-934-0920
Practice Address - Street 1:28538 DUPONT BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:MILLSBORO
Practice Address - State:DE
Practice Address - Zip Code:19966-4791
Practice Address - Country:US
Practice Address - Phone:302-934-0944
Practice Address - Fax:302-934-0920
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-18
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT016123207Q00000X
DEC2-0012700207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine