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General NPI Number Information
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NPI Number | 1851610737
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Entity Type | Organization
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Legal Business Name | CANEY RUN EMERGENCY PHYSICIANS
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Dates
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Enumeration Date | 05/18/2010
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Last Update Date | 05/18/2010
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Provider Practice Location Address
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Address Line | 10141 US 59 RD
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City | WHARTON
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State | TX
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Zip | 77488-7224
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Country | US
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Telephone | 979-532-2500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 98572
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City | LAS VEGAS
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State | NV
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Zip | 89193-8572
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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 | PRESIDENT
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Name | JOSEPH H. GATEWOOD
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Credential | M.D.
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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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