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General NPI Number Information
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NPI Number | 1164472262
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Entity Type | Organization
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Legal Business Name | SHAWNEE TRAIL EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5575 WARREN PKWY
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City | FRISCO
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State | TX
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Zip | 75034-4062
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Country | US
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Telephone | 214-618-2000
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Fax | 214-618-2004
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Provider Business Mailing Address
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Address Line | PO BOX 42903
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City | PHILADELPHIA
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State | PA
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Zip | 19101-2903
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Country | US
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Telephone | 800-355-0808
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Fax | 214-712-2444
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOSEPH H. GATEWOOD
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Credential | MD
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Telephone | 214-712-2000
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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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