Provider Demographics
NPI:1093922916
Name:GATES, CALEB FRANK III (LAC CMT)
Entity type:Individual
Prefix:
First Name:CALEB
Middle Name:FRANK
Last Name:GATES
Suffix:III
Gender:M
Credentials:LAC CMT
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1199 MAIN AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-5259
Mailing Address - Country:US
Mailing Address - Phone:970-259-9488
Mailing Address - Fax:970-259-9488
Practice Address - Street 1:1199 MAIN AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-5259
Practice Address - Country:US
Practice Address - Phone:970-259-9488
Practice Address - Fax:970-259-9488
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-05-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO967171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist