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General NPI Number Information
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NPI Number | 1144507542
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Entity Type | Organization
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Legal Business Name | FOSSIL RIM EMERGENCY PHYSICIANS PLLC
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Dates
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Enumeration Date | 11/14/2011
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Last Update Date | 08/25/2019
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Provider Practice Location Address
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Address Line | 1021 HOLDEN ST
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City | GLEN ROSE
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State | TX
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Zip | 76043-4937
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Country | US
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Telephone | 254-897-2215
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Fax | 800-305-3233
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Provider Business Mailing Address
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Address Line | 13737 NOEL RD STE 1600
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City | DALLAS
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State | TX
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Zip | 75240-1331
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Country | US
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Telephone | 954-838-2371
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Fax | 214-712-2444
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MR. JOSEPH GATEWOOD
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Credential | MD
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Telephone | 954-838-2371
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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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