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General NPI Number Information
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NPI Number | 1003169996
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Entity Type | Organization
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Legal Business Name | CRESTSIDE EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 07/05/2013
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Provider Practice Location Address
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Address Line | 700 MEDICAL BLVD
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City | ENGLEWOOD
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State | FL
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Zip | 34223-3964
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Country | US
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Telephone | 941-475-6571
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 37903
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City | PHILADELPHIA
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State | PA
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Zip | 19101-0403
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH H GATEWOOD
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Credential | MD
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Telephone | 727-507-2513
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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