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General NPI Number Information
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NPI Number | 1912066085
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Entity Type | Organization
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Legal Business Name | GATEWAY INTERNAL MEDICINE AND PEDIATRIC ASSOCIATES PLLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 05/25/2012
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Provider Practice Location Address
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Address Line | 103 COMMONWEALTH DRIVE
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City | MT STERLING
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State | KY
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Zip | 40353-9317
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Country | US
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Telephone | 859-498-7716
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Fax | 859-497-0044
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Provider Business Mailing Address
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Address Line | PO BOX 689
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City | MT STERLING
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State | KY
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Zip | 40353-0689
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Country | US
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Telephone | 859-498-7716
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Fax | 859-497-0044
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MRS. DONNA LYNN RAPER
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Credential |
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Telephone | 859-498-7715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RA0000X
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Taxonomy Name | Adolescent Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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