Basic Information
| Provider Information | |||||||||
| NPI: | 1063462299 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | G.T. EMERGENCY PHYSICIANS PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13737 NOEL RD | ||||||||
| Address2: | STE 1600 | ||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752401331 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 608 STRICKLAND DR | ||||||||
| Address2: | |||||||||
| City: | ORANGE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 776304717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098831248 | ||||||||
| FaxNumber: | 4098831149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 08/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | GATEWOOD | ||||||||
| AuthorizedOfficialFirstName: | JOSEPH | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | ENROLLMENT | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0043KP | 01 | TX | BLUE SHIELD | OTHER |