Dentravious Gates
Individual provider Active NPI Physical Medicine & Rehabilitation Physician · Baldwyn, MS
NPI 1992534044 · NPPES record last updated Jul 29, 2024
Key facts
- NPI
- 1992534044
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- License
- 6841 (MS)
- Practice address
- 220 Hill Top HTS
Baldwyn, MS 38824-9783 - Phone
- (662) 216-6672
- NPI assigned
- Jul 29, 2024
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6841 | MS | MD | Physical Medicine & Rehabilitation Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician | 208100000X | 6841 | MS | Yes |
Addresses
Primary practice location
220 Hill Top HTS
Baldwyn, MS 38824-9783
Mailing address
220 Hill Top HTS
Baldwyn, MS 38824-9783
Phone (662) 216-6672
Other providers in Baldwyn, MS
- Richard Comer
- Louise Cristo
- Dpti Elite Physical Therapy LLC
- Brandon Erby
- Miranda Lou Ford
- Graham Services, Inc.
- Thomas G Graham Jr.
- Lauren Mackenzie Guin
- Heather Hancock
- Haven Home Health LLC
All providers in Baldwyn, MS · Physical Medicine & Rehabilitation Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.