MEDICARE: GATEWAY MEDICAL GROUP LC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0071118	FL
2	207R00000X	Internal Medicine Physician	ME0077602	FL
3	207R00000X	Internal Medicine Physician	ME0071683	FL
4	208800000X	Urology Physician	ME0080601	FL
5	208600000X	Surgery Physician	ME0021272	FL
6	2084N0400X	Neurology Physician	ME0069465	FL
7	208000000X	Pediatrics Physician	ME0060312	FL
8	207ZP0105X	Clinical Pathology/Laboratory Medicine Physician	ME0060313	FL
9	207V00000X	Obstetrics & Gynecology Physician	ME0021723	FL
10	207RP1001X	Pulmonary Disease Physician	ME0057971	FL
11	207RG0100X	Gastroenterology Physician	ME0066502	FL
12	207RC0000X	Cardiovascular Disease Physician	ME0043238	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124012422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATEWAY MEDICAL GROUP LC

Provider Business Mailing Address
First Line	:	312 NW 5TH ST
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-2565
Country	:	US
Telephone Number	:	863-467-7084
Fax Number	:	863-467-6833

Provider Business Practice Location Address
First Line	:	111 NE 19TH DR
Second Line	:
City	:	OKEECHOBEE
State	:	FL
Zip	:	34972-1933
Country	:	US
Telephone Number	:	863-357-1068
Fax Number	:

Authorized Official
Title or Position	:	COO
Name	:	MR. JOHN SMITH
Credential	:
Telephone Number	:	863-467-7084

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	09/11/2025

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Directions to “GATEWAY MEDICAL GROUP LC ” Practice Location

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