Healthcare Provider Details

I. General information

NPI: 1700138997
Provider Name (Legal Business Name): HARBOR BLVD EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2012
Last Update Date: 07/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21298 OLEAN BLVD
PORT CHARLOTTE FL
33952-6705
US

IV. Provider business mailing address

PO BOX 37902
PHILADELPHIA PA
19101-0402
US

V. Phone/Fax

Practice location:
  • Phone: 941-627-6130
  • Fax: 941-627-6146
Mailing address:
  • Phone: 800-355-0808
  • Fax: 610-834-2862

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH H GATEWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 214-712-2000