Healthcare Provider Details

I. General information

NPI: 1093143513
Provider Name (Legal Business Name): LAKE GIBBONS EMERGENCY PHYSICIANS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2013
Last Update Date: 11/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 DESHONG DR
PARIS TX
75460-9313
US

IV. Provider business mailing address

13737 NOEL RD STE 1600
DALLAS TX
75240-1331
US

V. Phone/Fax

Practice location:
  • Phone: 903-785-4521
  • Fax:
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: JOSEPH H GATEWOOD
Title or Position: PRESIDIENT
Credential: MD
Phone: 469-401-2386