Basic Information
| Provider Information | |||||||||
| NPI: | 1902802697 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GATES | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | I. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 36014 TH ST | ||||||||
| Address2: | STOP 8143 | ||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794308143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432757 | ||||||||
| FaxNumber: | 8067431071 | ||||||||
| Practice Location | |||||||||
| Address1: | 3601 4TH ST # MS 8143 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794300001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8067432757 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2005 | ||||||||
| LastUpdateDate: | 03/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | F6654 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LH0002X | F6654 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | 207QH0002X | F6654 | TX | N | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 207Q00000X | F6654 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 113392100 | 05 | TX | MEDICAID | 52362 | 01 | NM | PRESBYTERIAN COMMERCIAL | OTHER | A229 | 01 | TRIWEST | OTHER | 100162480A | 05 | OK | MEDICAID | 80946Z | 01 | TX | HMO BLUE | OTHER | 87172G | 01 | TX | BC/BS | OTHER | 113392101 | 01 | TX | FIRSTCARE COMMERCIAL | OTHER | 136881307 | 05 | TX | MEDICAID | 136881308 | 05 | TX | MEDICAID | 52362 | 05 | NM | MEDICAID | H3719 | 05 | NM | MEDICAID |