Individual
MR. DALE EDWARD BATES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS PA-C
Contact information
Practice address
1001 LAKESIDE AVE E, SUITE 1000, CLEVELAND, OH 44114-1158
(440) 479-5349
(216) 420-9354
Mailing address
36385 SANDY KNOLL DR, EASTLAKE, OH 44095-5407
(440) 479-5349
(440) 953-0322
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
50.000692
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1026099
NATIONAL NCCPA #
OH
01
—
50.000692
OHIO STATE LICENSE
OH
Enumeration date
12/28/2006
Last updated
07/08/2007
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