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Individual

RODNEY BATES JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
36 PROFESSIONAL PLZ, REXBURG, ID 83440-2049
(208) 359-9411
(208) 656-8444
Mailing address
36 PROFESSIONAL PLZ, REXBURG, ID 83440-2049
(208) 359-9411
(208) 656-8444

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
O-0359
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010151181
REGENCE BLUE SHIELD OF ID
ID
05
807206700
ID
01
S5759
BLUE CROSS OF IDAHO
ID
Enumeration date
06/21/2006
Last updated
01/30/2012
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