=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396099149
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TRAVIS EMERGENCY PHYSICIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2012
-----------------------------------------------------
Last Update Date | 11/01/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 333 N SANTA ROSA ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78207-3108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-704-2011
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18167 US HIGHWAY 19 N SUITE 650
-----------------------------------------------------
City | CLEARWATER
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33764-3528
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/GENERAL PARTNER
-----------------------------------------------------
Name | DR. JOSEPH H. GATEWOOD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 214-712-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------