Healthcare Provider Details

I. General information

NPI: 1770892002
Provider Name (Legal Business Name): KEY VACA EMERGENCY PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2010
Last Update Date: 06/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 OVERSEAS HWY
MARATHON FL
33050-2329
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 305-743-5533
  • Fax: 305-743-3962
Mailing address:
  • Phone: 469-401-2386
  • Fax: 214-712-2444

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: MR. JOSEPH H. GATEWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 469-401-2386