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General NPI Number Information
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NPI Number | 1962574897
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Entity Type | Organization
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Legal Business Name | DAMON GATEWOOD MD PLLC
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 06/05/2014
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Provider Practice Location Address
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Address Line | 58 CITATION LANE
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-1426
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Country | US
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Telephone | 502-532-7341
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Fax | 502-532-0127
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Provider Business Mailing Address
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Address Line | 58 CITATION LANE
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City | CAMPBELLSBURG
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State | KY
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Zip | 40011-1426
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Country | US
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Telephone | 502-532-7341
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Fax | 502-532-0127
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAMON L GATEWOOD
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Credential | MD
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Telephone | 502-532-7341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3007904
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 37028
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License Number State | KY
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