Provider Demographics
NPI:1548674989
Name:GATES, CLINTON RAY (MD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:RAY
Last Name:GATES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2861 NE INDEPENDENCE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064-2379
Mailing Address - Country:US
Mailing Address - Phone:816-525-2840
Mailing Address - Fax:816-525-2841
Practice Address - Street 1:19101 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6904
Practice Address - Country:US
Practice Address - Phone:816-525-2840
Practice Address - Fax:816-525-2841
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-13
Last Update Date:2024-12-06
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Provider Licenses
StateLicense IDTaxonomies
KS04-42370208600000X
MO2019014998208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery