Healthcare Provider Details

I. General information

NPI: 1871776872
Provider Name (Legal Business Name): FC EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 12/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17240 CORTEZ BLVD
BROOKSVILLE FL
34601
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 352-796-5111
  • Fax:
Mailing address:
  • Phone: 469-401-2386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH GATEWOOD
Title or Position: PRESIDENT
Credential:
Phone: 469-401-2386