MEDICARE: GATOR TOWN PEDIATRICS FAMILY & URGENT CARE 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	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1316927577	OTHER	TX	EMERGENCY

General Provider Information

NPI Number	:	1720801046
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GATOR TOWN PEDIATRICS FAMILY & URGENT CARE PLLC

Provider Business Mailing Address
First Line	:	303 FM 517 RD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	346-617-8598
Fax Number	:	855-576-2458

Provider Business Practice Location Address
First Line	:	303 FM 517 RD E
Second Line	:
City	:	DICKINSON
State	:	TX
Zip	:	77539-8630
Country	:	US
Telephone Number	:	346-617-8598
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JAMES S VINCENT
Credential	:	MD
Telephone Number	:	832-626-3003

Provider Enumeration Date	:	11/05/2024
Last Update Date	:	03/12/2026

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