Individual
MR. MATTHEW BATES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MATTHEW BATES
Contact information
Practice address
4101 N POTTENGER AVE, SHAWNEE, OK 74804-1262
(719) 352-7058
Mailing address
4101 N POTTENGER AVE, SHAWNEE, OK 74804-1262
(719) 352-7058
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
105858
OK
Other
Enumeration date
07/20/2012
Last updated
07/20/2012
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