Provider Demographics
NPI:1295558898
Name:GATES, ZACHARY LAWRENCE
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:LAWRENCE
Last Name:GATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:371 N 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46060-2147
Mailing Address - Country:US
Mailing Address - Phone:224-545-6765
Mailing Address - Fax:
Practice Address - Street 1:54 N 9TH ST STE 260
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46060-2208
Practice Address - Country:US
Practice Address - Phone:317-645-7691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program