=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487841011
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PERC EMERGENCY PHYSICIANS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2007
-----------------------------------------------------
Last Update Date | 04/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1612 HURST TOWN CENTER DR
-----------------------------------------------------
City | HURST
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76054-6236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-345-4100
-----------------------------------------------------
Fax | 800-305-3233
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 815 S PALAFOX ST STE. 300
-----------------------------------------------------
City | PENSACOLA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32502-5960
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-444-7009
-----------------------------------------------------
Fax | 800-444-7009
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRES., TERS., GENERAL PARTNER
-----------------------------------------------------
Name | JOSEPH H GATEWOOD
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 800-362-2731
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207P00000X
-----------------------------------------------------
Taxonomy Name | Emergency Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------