Healthcare Provider Details

I. General information

NPI: 1467401380
Provider Name (Legal Business Name): CRANE EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

159 N 3RD ST
MACCLENNY FL
32063-2103
US

IV. Provider business mailing address

PO BOX 13378
PHILADELPHIA PA
19101-3378
US

V. Phone/Fax

Practice location:
  • Phone: 904-259-3151
  • Fax: 904-259-3160
Mailing address:
  • Phone:
  • 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: DR. JOSEPH H. GATEWOOD
Title or Position: PRESIDENT
Credential:
Phone: 214-712-2000