MEDICARE: SEA RIM EMERGENCY PHYSICIANS PLLC

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	207P00000X	Emergency Medicine Physician

General Provider Information

NPI Number	:	1134542137
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEA RIM EMERGENCY PHYSICIANS PLLC

Provider Business Mailing Address
First Line	:	13737 NOEL RD
Second Line	:	STE 1600
City	:	DALLAS
State	:	TX
Zip	:	75240-1331
Country	:	US
Telephone Number	:	469-401-2386
Fax Number	:	214-712-2444

Provider Business Practice Location Address
First Line	:	8445 MEMORIAL BLVD
Second Line	:	STE 600
City	:	PORT ARTHUR
State	:	TX
Zip	:	77640-7003
Country	:	US
Telephone Number	:	409-989-5400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH GATEWOOD
Credential	:	MD
Telephone Number	:	469-401-2386

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/27/2014

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