Healthcare Provider Details

I. General information

NPI: 1851610737
Provider Name (Legal Business Name): CANEY RUN EMERGENCY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2010
Last Update Date: 05/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 US 59 RD
WHARTON TX
77488-7224
US

IV. Provider business mailing address

PO BOX 98572
LAS VEGAS NV
89193-8572
US

V. Phone/Fax

Practice location:
  • Phone: 979-532-2500
  • Fax:
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

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: PRESIDENT
Credential: M.D.
Phone: 214-712-2000