MEDICARE: MR. LANCE BUTLER GATEWOOD M.S., C.C.P.

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	242T00000X	Perfusionist	940094-0297	AZ

General Provider Information

NPI Number	:	1720291677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. LANCE BUTLER GATEWOOD M.S., C.C.P.

Provider Business Mailing Address
First Line	:	4344 W TELLURITE DR
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85745-4192
Country	:	US
Telephone Number	:	520-219-3822
Fax Number	:	520-219-3822

Provider Business Practice Location Address
First Line	:	1501 N CAMPBELL AVE
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85724-5071
Country	:	US
Telephone Number	:	520-626-6339
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/08/2007

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