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General NPI Number Information
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NPI Number | 1699786699
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Entity Type | Organization
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Legal Business Name | CANNON EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 1110 N SARAH DEWITT DR EMERGENCY DEPARTMENT
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City | GONZALES
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State | TX
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Zip | 78629-3311
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Country | US
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Telephone | 830-672-7581
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Fax | 830-672-4319
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Provider Business Mailing Address
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Address Line | 815 S PALAFOX ST 3RD FLOOR
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City | PENSACOLA
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State | FL
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Zip | 32502-5937
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Country | US
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Telephone | 800-444-7009
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Fax | 800-305-3233
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Authorized Official
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Title or Position | PRES TEXAS EMER ROOM SERVICES PA
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Name | JOSEPH H GATEWOOD
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Credential | MD
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Telephone | 800-427-2145
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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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